Older Adults in Traditional Medicare Spend Weeks Per Year on Health Care Contact Days

A cross-sectional study found that older adults in traditional Medicare spent an average of 3 weeks in the year receiving care outside the home for various reasons, mostly ambulatory care like office visits, tests, and treatments. Days spent obtaining health care outside the home may show access to needed care, but also add up to substantial time, effort, and cost burdens to patients and those who care for them, according to the study authors.

The findings, which are the first to the authors’ knowledge to characterize health care contact days among older adults in traditional Medicare, were published in Annals of Internal Medicine.

Health care illustration | Image credti: maxsim - stock.adobe.com

Health care contact days are an intuitive, claims-based way to capture health care outside the home, a metric the authors explained has potential to be used more broadly but is not yet well understood. The idea of using health care contact days stems from existing measures such as time at home and healthy days at home, both of which assess days spent outside of institutional care such as hospitals and nursing homes.

“Understanding how older adults use contact days could provide an empirical foundation for this dimension of person-centered care to inform individual patient care decisions, improve health system operations, guide Medicare policies, and support evaluation of clinical interventions alongside other key dimensions of patient health and well-being,” the authors wrote.

The study aimed to characterize health care contact days among older, community-dwelling adults in traditional Medicare by using administrative claims linked to national survey data. The researchers assessed how the use and composition of health care contact days varied in the overall population in patient subgroups, as well as the patterns of contact days relevant to care coordination. They also analyzed sociodemographic, clinical, and functional factors and behaviors that may explain the use of health care contact days and any variations seen in the study.

Using the nationally representative 2019 Medicare Current Beneficiary Survey data linked to claims, the researchers measured ambulatory contact days, which encompassed days with a primary or specialty care office visit, test, imaging, procedure, or treatment, and total contact days, which encompassed ambulatory days plus institutional days in a hospital, emergency department, skilled-nursing facility, or hospice facility. Patient factors associated with contact days were identified through multivariable mixed-effects Poisson.

Weighted results show that 6619 older adults (weighted: 29,694,084) had a mean (SD) of 17.3 (22.1) ambulatory contact days in the year, with 20.7 (27.5) total contact days. However, 11.1% had 50 or more total contact days.

Most contact days were spent on ambulatory care, which included a mean of 3.5 (5.0) days for primary care visits, 5.7 (9.6) days for specialty care visits, 5.3 (7.2) days for tests, 2.6 (3.9) days for imaging, 2.5 (6.4) days for procedures, and 5.7 (13.3) days for treatments.

Further, laboratory tests (72.6% of test days); standard radiographs (52.9% of imaging days); physical, occupational, and speech therapy (43.7% of treatment days); and skin procedures (50.5% of procedure days) were the most common types of services on ambulatory service contact days in the study population.

The study revealed opportunities to consolidate contact days. For example, about half of test days (48.6%) and imaging days (50.1%) were on different days from office visits.

The authors identified several factors associated with increased ambulatory contact days, including younger age, female sex, White race, non-Hispanic ethnicity, higher income, higher educational attainment, urban residence, more chronic conditions, and care-seeking behaviors.

The study was limited by the inclusion of only those enrolled in traditional Medicare, as well as the inability to adjudicate the value of individual contact days, which may vary with the potential benefits and burdens associated with them. The authors also acknowledge that the study only encompassed care outside the home and that home-based care can also take time and increase burden on patients and caregivers.

“Taken together, our results highlight the substantial imprint of ambulatory health care on older adults’ lives,” the authors wrote. “They demonstrate that much of the variation in contact days cannot be explained by clinical need—consistent with broader literature on variation in health care utilization—and imply important roles for clinician and health system practice variation as well as unmeasured patient and area factors (for example, climate and traffic). These results further suggest that there are opportunities to optimize contact days, for example, through care coordination."

Reference

Ganguli I, Chant ED, Orav EJ, Mehrotra A, Ritchie CS. Health care contact days among older adults in traditional Medicare: a cross-sectional study. Ann Intern Med. Published online January 23, 2024. doi:10.7326/M23-2331