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Health Services Research & Development

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2015 HSR&D/QUERI National Conference Abstract

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1120 — Does Medical Foster Home Placement Prevent Hospitalization?

Levy C, Denver/Seattle COIN; Alemi F, Washington DC VAMC; Williams AR, Bay Pines VAMC; Wojtusiak J, George Mason University; Sutton B, James A Haley VAMC; Giang P, George Mason University; Pracht E, University of South Florida; Argyros L, Bay Pines VAMC; Williams AE, Bay Pines VAMC;

Objectives:
This study compares hospitalization rates for common conditions in the Veteran Affairs (VA) Medical Foster Home (MFH) program to VA nursing homes, known as Community Living Centers (CLC).

Methods:
We matched 817 MFH residents to 3 CLC residents selected from a pool of 325,031 CLC residents. CLC and MFH cases were matched on (1) baseline time period, (2) follow up time period, (3) age, (4) gender, (5) race, (6) risk of mortality calculated from comorbidities on last admission prior to entering the program, and (7) history of hospitalization for the selected condition during the baseline period.Odds ratio (OR) and related confidence interval (CI) were calculated to contrast the MFH cases and matched CLC controls.

Results:
Compared to matched CLC cases, MFH residents were less likely to be hospitalized for adverse care events, which included complications related to artificial implants, surgical procedures, and urinary catheters (OR = 0.13, 95% CI 0.03, 0.53), anxiety disorders (OR = 0.52, 95%CI 0.33,0.80), mood disorders (OR = 0.57, 95%CI 0.42,0.79), skin infections (OR = 0.22, 95%CI 0.10,0.51), pressure ulcers (OR = 0.22, 95%CI 0.09,0.50) and bacterial infections other than tuberculosis or septicemia (OR = 0.54, 95% CI 0.31, 0.92). MFH cases and matched CLC controls did not differ in rates of urinary tract infections, pneumonia, septicemia, suicide/self-injury, falls, other injury besides falls, history of injury, delirium/dementia/cognitive impairments, or adverse drug events. Hospitalization rates were not higher for any of the conditions studied in the MFH cohort compared to the CLC cohort.

Implications:
MFH participants had the same or lower rates of hospitalizations for the conditions examined compared to CLC controls which may be attributable to care provision by consistent caregivers in these smaller MFH home care environments.

Impacts:
As medical foster homes are offered as an alternative to traditional nursing home care, an evaluation of outcomes is essential to monitor the safety of care provided by non-familial, informal caregivers. Supporting informal caregivers with home-based primary care in these smaller care environments did not lead to higher rates of hospitalizations for the selected conditions among medical foster home residents compared to Veterans residing in Community Living Centers.