title: Homebound older adults: Prevalence, characteristics, health care utilization and quality of care.
abstract: The purpose of this study was to estimate prevalence rates of homebound older adults, their characteristics and the impact of homebound status on health care utilization, expenditures and quality of medical care measures. Surveys were sent to new enrollees (n = 25,725) in AARP(®) Medicare Supplement plans (insured through UnitedHealthcare) to screen for serious chronic conditions, ambulatory disabilities and eligibility for care coordination programs. Health care utilization and expenditures were determined from paid claims. Member-level quality measures considered compliance with medication adherence and care patterns. Among survey respondents, 19.6% were classified as being homebound. The strongest predictors of being homebound included serious memory loss, being older, having more chronic conditions, taking more prescription medications and having multiple hospitalizations. Homebound had significantly higher health care utilization and expenditures. Homebound were more likely to be noncompliant with medication adherence and care pattern rules. Ongoing screening and subsequent interventions for new enrollees classified as homebound may be warranted.
authors.affiliation: Advanced Analytics, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI 48108, USA. Electronic address: shirley.musich@optum.com.
authors.forename: Shirley
authors.initials: S
authors.lastname: Musich
authors.affiliation: Advanced Analytics, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI 48108, USA.
authors.forename: Shaohung S
authors.initials: SS
authors.lastname: Wang
authors.affiliation: Advanced Analytics, Optum, 315 E. Eisenhower Parkway, Suite 305, Ann Arbor, MI 48108, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Hawkins
authors.affiliation: AARP Services, Inc., 601 E. Street, N.W., Washington, D.C. 20049, USA.
authors.forename: Charlotte S
authors.initials: CS
authors.lastname: Yeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D018577:Homebound Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance; D015995:Prevalence; D011446:Prospective Studies; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States
keywords: Health care expenditures; Health care utilization; Homebound; Quality of care