A comparison of comorbidity, depression, and social support of elderly home care patients who are identified as outliers and elderly home care patients who are identified as non-outliers under the Medicare Prospective Payment System.

摘要

Beginning October 1, 2000 Medicare has reimbursed home health care through the Prospective Payment System. Factors absent in this reimbursement formula are co-morbidity, depression, and social support. This comparative, exploratory study was designed to determine differences between outliers and non-outliers, with regards to co-morbidity, depression, and social support. The Theory of Bureaucratic Caring was the theoretical framework utilized.;Twenty elderly outliers, representing the entire outlier sample, and 80 elderly randomly sampled non-outliers of a large home care agency were studied. Participants completed a demographic form, the Geriatric Depression Scale - Short Form, and the Norbeck Social Support Questionnaire. Statistical analysis included the t Test, Pearson Product Moment Correlation, Spearman rho Correlation, Eta Correlation Procedure, Chi-square, and Mann Whitney test. Outliers had a high incidence of primary diagnoses requiring wound care (55%), were significantly younger (p = .001), and had significantly higher levels of the social support subscale aid (p = .05).;Co-morbidity was high for outliers and non-outliers (median: 3.00 and 4.00, respectively). Depression scores for outliers and non-outliers indicated high levels of possible depression (15% and 36%, respectively), and depression (10% and 8%, respectively). Social support scores were low for outliers and non-outliers (mean: 198.100 and 127.5375, respectively). Number of support network members was low for outliers and non-outliers (median: 4.50 and 3.00, respectively). Depression was significantly correlated with social support (r = .51 to .83) and co-morbidity (r = .33 to .49) for both groups. There was no significant difference between outliers and non-outliers for co-morbidity, depression, and total social support ( p > .05).