# Implications of the Patient-Driven Grouping Model on Home Health Care Utilization and Outcomes for Persons with Alzheimer's and Related Dementias

> **NIH NIH P01** · BROWN UNIVERSITY · 2024 · $387,690

## Abstract

PROJECT SUMMARY
Individuals with Alzheimer's disease and related dementias (ADRD) are increasingly opting to remain in the
community, resulting in a heightened reliance on Medicare's skilled home health care services. About a third of
all home health recipients have ADRD, highlighting the significance of ADRD within the home health sector. The
implementation of the Patient-Driven Groupings Model (PDGM) on January 1, 2020, represents a significant
alteration in the reimbursement landscape for Medicare-certified home health agencies. In contrast to the prior
volume-driven payment system which incentivized home health agencies to overprovide therapy, the PDGM now
pays home health agencies based on patient characteristics at admission. With the PDGM came several
significant modifications including: halving episodes of care from 60 to 30 days, reducing the payment rate after
the initial 30 days, and diminishing reimbursement rates for community-initiated services. Our research team has
previously shown that persons with ADRD use home health care in systematically different ways than persons
without ADRD, including requiring longer episodes of care and being more likely to use community-initiated care
(vs. post-acute care). As such, it is critical to understand how this significant payment model change will impact
home health services for people with ADRD.
This study seeks to bridge this knowledge gap by exploring the impact of the PDGM on home health care access
and quality for patients with ADRD, pinpointing factors influencing patient outcome disparities, and capturing
stakeholder perspectives within the PDGM framework. Our guiding hypothesis is that the PDGM, while designed
to enhance home health care delivery for the broader populace, might inadvertently adversely impact care and
outcomes for people with ADRD. To delve into this hypothesis, we propose a mixed-methods study. We will
employ a dynamic difference-in-difference analytical model, leveraging Medicare claims and related
administrative datasets, to estimate the differential impacts of the PDGM on patients with vs. without ADRD.
Simultaneously, we will use qualitative data to garner in-depth insights from a range of home health care
providers, shedding light on their experiences, challenges, and adaptive strategies within the PDGM context. In
summation, this study will offer the first comprehensive, national evaluation of the PDGM's impact on home
health care delivery and key outcomes (mortality, hospitalizations, change in function), specifically focusing on
people with ADRD. The findings are expected to equip patients, caregivers, home health agencies, and
policymakers with robust empirical evidence to guide informed decisions within the evolving home health care
environment.

## Key facts

- **NIH application ID:** 10934972
- **Project number:** 2P01AG027296-16
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Md Momotazur Rahman
- **Activity code:** P01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $387,690
- **Award type:** 2
- **Project period:** 2007-09-15 → 2029-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10934972

## Citation

> US National Institutes of Health, RePORTER application 10934972, Implications of the Patient-Driven Grouping Model on Home Health Care Utilization and Outcomes for Persons with Alzheimer's and Related Dementias (2P01AG027296-16). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10934972. Licensed CC0.

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