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 sub-acute rehabilitation, and AIM program utilization during the pandemic with rates one year prior.

Results

Acute and post-acute utilization for enrollees (n=1,468) decreased March-May 2020 compared to one year prior (n=1,452), while utilization of AIM program resources remained high. Comparing 2019 and 2020, ED visits/1000 enrollees were 109 versus 44 (p<0.001), inpatient admissions 213 versus 113 (p<0.001), and rehabilitation facility admissions 56 versus 31 (p=0.014); AIM program home visits were 1935 versus 276 (p<0.001), remote visits (telehealth/telephonic) 0 versus 1079 (p<0.001), and all other phone touches 3032 versus 5062 (p<0.001). Home hospice admissions/1000 increased: 16 to 31 (p=0.011).

Discussion and Implications

Our results demonstrate decreased acute and post-acute utilization, while maintaining high levels of connectedness to the AIM program, amongst a cohort of homebound older adults during the COVID-19 pandemic compared with one 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.