Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care

Area of Science:

• Gerontology
• Health Services Research
• Primary Care Medicine

Background:

• Home-based primary care (HBPC) is crucial for high-need older adults.
• Current patient targeting for HBPC is inconsistent, limiting program evaluation and expansion.

Purpose of the Study:

• To develop and validate criteria for identifying appropriate target populations for HBPC.
• Establish objective criteria to guide HBPC program expansion and evaluation.

Main Methods:

• A modified Delphi process involving 29 experts achieved consensus on HBPC target population criteria.
• Criteria were validated using linked Medicare claims and National Health and Aging Trends Study (NHATS) data (n=21,727).
• Construct validation assessed demographics, health outcomes, and expenditures.

Main Results:

• An algorithm with criteria for serious illness, functional impairment, and social isolation was developed.
• The algorithm identified 16.8% of Medicare beneficiaries as suitable for HBPC.
• Identified populations exhibited significantly higher healthcare costs and 12-month mortality compared to the general cohort.

Conclusions:

• A validated algorithm for defining HBPC target populations was successfully developed.
• The findings indicate a need for expanded HBPC services.
• This algorithm facilitates objective identification of HBPC needs, supporting robust evaluation and equitable expansion.