title: Volume of home- and community-based Medicaid waiver services and risk of hospital admissions.
abstract: OBJECTIVE
  To evaluate whether type and volume of Medicaid Home- and Community-Based Services (HCBS) waiver program are associated with risk of hospitalization and whether this association changes over time.
  
  
  METHODS
  Prospective.
  
  
  METHODS
  Indiana Medicaid claims data from June 2001 to December 2004.
  
  
  METHODS
  Medicaid recipients (N=1,354) who enrolled in the Aged and Disabled waiver program between January 2002 and June 2004.
  
  
  METHODS
  Time to hospital admission since enrollment in the HCBS waiver program, adjusted for demographics, comorbidities, prior use of health services, and volume of HCBS received, including attendant care, homemaking, and home-delivered meals.
  
  
  RESULTS
  A greater volume of attendant care, homemaking services, and home-delivered meals was associated with a lower risk of hospitalization. This effect diminished over time for attendant care and homemaking. The risk of hospitalization for subjects receiving 5 hours of attendant care per month was 54% (hazard ratio (HR)=0.46, 95% confidence interval (CI)=0.38-0.57) lower during the first month of enrollment and 20% lower by Month 10 (HR=0.80, 95% CI=0.73-0.88) than for those receiving no attendant care.
  
  
  CONCLUSIONS
  Greater volume of HCBS services was associated with lower risk of hospitalization. The findings highlight the potential importance of assessing and monitoring the volume of HCBS patients receive.
authors.affiliation: Department of Mathematics and Statistics, Mississippi State University, Mississippi State, Mississippi, USA.
authors.forename: Huiping
authors.initials: H
authors.lastname: Xu
authors.forename: Michael
authors.initials: M
authors.lastname: Weiner
authors.forename: Sudeshna
authors.initials: S
authors.lastname: Paul
authors.forename: Joseph
authors.initials: J
authors.lastname: Thomas
authors.forename: Bruce
authors.initials: B
authors.lastname: Craig
authors.forename: Marc
authors.initials: M
authors.lastname: Rosenman
authors.forename: Caroline Carney
authors.initials: CC
authors.lastname: Doebbeling
authors.forename: Laura P
authors.initials: LP
authors.lastname: Sands
mesh_terms: D000368:Aged; D003153:Community Health Services / Q000706:statistics & numerical data*; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012306:Risk; D014481:United States