识别具有长期服务和支持的双重资格受益人 在医疗保险入学数据中使用
Laura M Keohane1, Emmaline Keesee1, Chanee D Fabius2
1Vanderbilt University School of Medicine, Nashville, TN, USA.
Medical care research and review : MCRR
|December 8, 2025
概括
识别使用医疗补助长期服务和支持 (LTSS) 的双重资格受益人是一项挑战. 一项新的战略使用医疗保险D部分数据准确识别养老院和家庭和社区服务豁免用户.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 老年学是指老年学的学科.
- 公共卫生政策 公共卫生政策
背景情况:
- 识别利用Medicaid资助的长期服务和支持 (LTSS) 的双重资格受益者对于质量监测和改进至关重要.
- 目前的方法在准确捕捉这一群体方面面临挑战,特别是那些接受家庭和社区服务 (HCBS) 的人群.
研究的目的:
- 展示一种新的策略,用于识别使用Medicaid资助的LTSS的双重资格受益者,特别是养老院 (NH) 居民和HCBS豁免参与者.
- 为了利用医疗保险D部分数据,特别是零成本共享状态,作为LTSS利用的代理.
主要方法:
- 利用医疗保险入学记录来识别零D部分成本共享的受益人,称为D部分LTSS受益人.
- 通过与养老院评估 (MDS) 和Medicaid HCBS数据进行交叉引用来验证LTSS的使用,在多州低收入老年人队列中.
- 评估了部分D数据策略在识别实际NH和HCBS豁免用户方面的准确性.
主要成果:
- 该战略准确地确定了超过96%的已知NH/HCBS豁免用户作为D部分LTSS受益者.
- 相反,93%没有记录使用NH或HCBS豁免的受益人被正确确定为不是D部分LTSS受益人.
- 在仅使用医疗保险数据识别目标人群方面表现出高精度和回忆力.
结论:
- 利用医疗保险D部分零成本共享数据提供了一种可行且准确的方法来识别使用LTSS的双重资格受益人.
- 这种方法可以促进更及时的证据产生的质量和结果对于这个脆弱的人群.
- 该战略有可能改善对双重符合条件的LTSS用户的护理监测和管理.
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