Association of Vision Loss With Hospital Use and Costs Among Older Adults
Association of Vision Loss With Hospital Use and Costs Among Older Adults
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DOI：
10.1001/jamaophthalmol.2019.0446
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发表时间：
2019-06-01
影响因子：
8.1
通讯作者：
Stein, Joshua D.
中科院分区：
文献类型：
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作者：
Morse, Alan R.;Seiple, William;Stein, Joshua D.
重要信息由于常见疾病而住院的视力丧失患者通常不会被认为需要特别照顾。然而，这种看法可能会影响这些人的结果、资源使用和成本。目的评估视力丧失患者与非视力丧失患者在相似的医疗条件下的平均住院时间、再住院率和住院费用是否存在差异。设计、设置和参与者此医疗保健索赔数据的分析使用了两个来源：Medicare数据库和Clinformatics Datamart。根据年龄、首次住院的年限、性别、种族/民族、居住的城市和总体健康状况，视力丧失的个体与非视力丧失(NVL)的个体1：1匹配。这两组人都有相同的医疗保险(联邦医疗保险或商业健康计划)，而且都曾因常见疾病住院。视力损失分为部分视力损失(PVL)和严重视力损失(SVL)。对2015年4月至2018年4月的数据进行了分析。主要结果和测量结果包括住院期间和出院后90天的住院时间、再住院率和医疗费用。建立多变量Logistic模型和线性回归模型，以确定与NVL、PVL和SVL组之间的这些结果相关的因素。结果在医疗保险受益人中，6165名NVL患者(平均年龄82.0[8.3]岁，其中3833名(62.2%)为女性)与6165名视力丧失患者匹配。视力丧失者中，PVL 3401例(55.2%)，SVL 2764例(44.8%)。在Clinformatics Datamart数据库中，5929名NVL患者(平均年龄73.7[15.1]岁，其中3587名(60.5%)为女性)与5929名视力丧失患者匹配。在有视力损失的商业保险参与者中，3515人(59.3%)患有PVL，2414人(40.7%)患有SVL。与NVL患者相比，SVL患者的平均住院时间更长(6.48vs5.26天)，再住院率更高(23.1%vs18.7%)，住院和出院后90天的费用也更高(64711美元vs61060美元)。与NVL患者相比，患有SVL的医疗保险受益人的住院时间延长了4%(估计比，1.04；95%CI，1.01-1.07；P=.02)，再入院几率高22%(优势比，1.22；95%CI，1.06-1.41；P=.007)，费用高12%(估计成本比，1.12；95%CI，1.06-1.18；P
ImportancePatients with vision loss who are hospitalized for common illnesses are often not identified as requiring special attention. This perception, however, may affect the outcomes, resource use, and costs for these individuals. ObjectiveTo assess whether the mean hospitalization lengths of stay, readmission rates, and costs of hospitalization differed between individuals with vision loss and those without when they are hospitalized for similar medical conditions. Design, Setting, and ParticipantsThis analysis of health care claims data used 2 sources: Medicare database and Clinformatics DataMart. Individuals with vision loss were matched 1:1 to those with no vision loss (NVL), on the basis of age, years from initial hospitalization, sex, race/ethnicity, urbanicity of residence, and overall health. Both groups had the same health insurance (Medicare or a commercial health plan), and all had been hospitalized for common illnesses. Vision loss was categorized as either partial vision loss (PVL) or severe vision loss (SVL). Data were analyzed from April 2015 through April 2018. Main Outcomes and MeasuresThe outcomes were lengths of stay, readmission rates, and health care costs during hospitalization and 90 days after discharge. Multivariable logistic and linear regression models were built to identify factors associated with these outcomes among the NVL, PVL, and SVL groups. ResultsAmong Medicare beneficiaries, 6165 individuals with NVL (with a mean [SD] age of 82.0 [8.3] years, and 3833 [62.2%] of whom were female) were matched to 6165 with vision loss. Of those with vision loss, 3401 (55.2%) had PVL and 2764 (44.8%) had SVL. In the Clinformatics DataMart database, 5929 individuals with NVL (with a mean [SD] age of 73.7 [15.1] years, and 3587 [60.5%] of whom were female) were matched to 5929 individuals with vision loss. Of the commercially insured enrollees with vision loss, 3515 (59.3%) had PVL and 2414 (40.7%) had SVL. Medicare enrollees with SVL, compared with those with NVL, had longer mean lengths of stay (6.48 vs 5.26 days), higher readmission rates (23.1% vs 18.7%), and higher hospitalization and 90-day postdischarge costs ($64711 vs $61060). Compared with those with NVL, Medicare beneficiaries with SVL had 4% longer length of stay (estimated ratio,1.04; 95% CI, 1.01-1.07; P=.02), 22% higher odds of readmission (odds ratio,1.22; 95% CI, 1.06-1.41; P=.007), and 12% higher costs (estimated cost ratio,1.12; 95% CI, 1.06-1.18; P