The effect of major and minor depression on Medicare home healthcare services use.
OBJECTIVE
To examine the associations between major and minor depression and categories of Medicare home healthcare use.


METHODS
Observational prospective study (1997-1999).


METHODS
Visiting nurse agency in suburban New York State. PARTCIPANTS: Five hundred thirty-nine new Medicare admissions aged 65 and older (mean age 78.4), 65.1% female, and 15.0% nonwhite. Approximately 13.5% were diagnosed with major depression and another 10.8% with minor depression.


METHODS
Consensus "best estimate"Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses for major and minor depression assessed using Structured Clinical Interviews for DSM-IV (SCID) plus medical charts.


RESULTS
Major and minor depression appear to have little association with probability and amount of use of the types of Medicare home health care (skilled nurse, home health aide, therapist (physical, occupational, and speech), and medical social services). Overall, patients with minor depression appear to have utilization similar to that of patients with major depression.


CONCLUSIONS
It seems likely that any potential incremental depression effect on utilization is being offset by the transitional medical state of the patients that entered Medicare home healthcare directly from a hospital, nursing home, or rehabilitation facility, and the overall severity of disability and chronic illness present in long-term home healthcare patients. Further research is required to determine whether similar findings occur in other home healthcare agencies and whether these are present under the current Medicare Prospective Payment System reimbursement mechanism.
Friedman
Bruce
B
Department of Community and Preventive Medicine, University of Rochester, Rochester, NY 14642, USA. Bruce_Friedman@urmc.rochester.edu
Delavan
Rachel L
RL
Sheeran
Thomas H
TH
Bruce
Martha L
ML
D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics; D009518:New York / Q000453:epidemiology; D009730:Nursing Assessment; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D014481:United States / Q000453:epidemiology