Acute, Post-acute, and Primary Care Utilization in a Home-Based Primary Care Program During COVID-19

Abstract

Background and objectives: Older adults with multiple comorbidities experience high rates of hospitalization and poor outcomes from Coronavirus Disease 2019 (COVID-19). Changes in care utilization by persons in advanced illness management (AIM) programs during the COVID-19 pandemic are not well known. The purpose of this study was to describe changes in care utilization by homebound AIM patients in an epicenter of the COVID-19 pandemic before and during the pandemic.

Research design and methods: Descriptive statistics and tests of differences were used to compare care utilization rates, including emergency department (ED) and inpatient admissions, acute and subacute rehabilitation, and AIM program utilization during the pandemic with rates 1 year prior.

Results: Acute and post-acute utilization for enrollees (n = 1,468) decreased March-May 2020 compared to 1 year prior (n = 1,452), while utilization of AIM program resources remained high. Comparing 2019 and 2020, ED visits/1,000 enrollees were 109 versus 44 (p < .001), inpatient admissions 213 versus 113 (p < .001), and rehabilitation facility admissions 56 versus 31 (p = .014); AIM program home visits were 1,935 versus 276 (p < .001), remote visits (telehealth/telephonic) 0 versus 1,079 (p < .001), and all other phone touches 3,032 versus 5,062 (p < .001). Home hospice admissions/1,000 increased: 16-31 (p = .011).

Discussion and implications: Our results demonstrate decreased acute and post-acute utilization, while maintaining high levels of connectedness to the AIM program, among a cohort of homebound older adults during the COVID-19 pandemic compared with 1 year prior. While further study is needed, our results suggest that AIM programs can provide support to this population in the home setting during a pandemic.

Keywords: Advanced illness management; Home-based medical care; Pandemic; SARS-CoV-2.