Acute, Post-Acute, and Primary Care Utilization in a Home-Based Primary Care Program during COVID-19

Abrashkin, Karen A; Zhang, Jenny; Poku, Asantewaa

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.