IDENTIFYING MEALS ON WHEELS CLIENTS AT RISK OF HOSPITALIZATION: A STRATEGY FOR ALLOCATING EXTRA HEALTH SERVICES

摘要

Increasingly, Meals on Wheels (MOW) programs are supplementing home-delivered meals with additional services, like in-home health and safety assessments. Due to limited MOW operating budgets, it is important for special services to be targeted to those who will most benefit. Using MOW administrative data linked to Medicare claims and census data, we performed a retrospective cohort analysis of 8,236 newly enrolled MOW clients from a convenience sample of nine programs across the US to identify characteristics of clients at highest risk for adverse outcomes. The hierarchical outcome variable was derived from clients’ outcomes 30 days after MOW enrollment; 1) 7,487 clients (91%) were alive with no inpatient admission (reference group), 2) 669 clients (8%) had one or more inpatient admission, and 3) 80 clients (1%) had died. We examined clients’ demographic, health, and residential characteristics as predictors of inpatient utilization, adjusting for the competing risk of death in a multinomial logistic regression with program fixed effects. Results suggest 65–74 year-old clients had a higher relative risk of an inpatient admission than older enrollees (RR=1.347, 95% CI [1.063, 1.707]). Presence of a chronic condition diagnosis (e.g. hypertension or depression) prior to enrollment conferred excess risk of inpatient admission, as did an inpatient admission (RR=1.663, 95% CI [1.367, 2.024]) or an emergency department visit (RR=1.661, 95% CI [1.298, 2.126]) in the 30 days prior to enrollment. Our results can help target health services to high-risk clients in MOW programs and further supports the integration of medical and social services.