Factors related to potentially preventable hospitalizations among the elderly
Factors related to potentially preventable hospitalizations among the elderly
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DOI：
10.1097/00005650-199806000-00004
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发表时间：
1998-06-01
期刊：
影响因子：
3
通讯作者：
Przybylski, M
中科院分区：
文献类型：
--
作者：
Culler, SD;Parchman, ML;Przybylski, M
目标。作者研究了住院治疗与门诊护理敏感状况相关的几率是否可以通过观察到的医疗保险受益人的易感性、能力和需求特征的差异来解释。对医疗保险行政住院病人索赔数据和医疗保险当前受益人调查进行了多变量横断面分析，调查对象是具有全国代表性的医疗保险受益人样本。每个医疗保险受益人的医院利用情况分为三类：(1)没有住院；(2)住院，但没有因潜在可预防的疾病住院；(3)至少一次潜在可预防的住院治疗。结果表明，年龄较大、黑人或居住在核心标准大都市统计区（SMSA）县或农村县的人，可预防住院的几率显著增加，而上过大学或只有医疗保险覆盖的人，可预防住院的几率会降低。此外，那些健康状况较差、患有冠心病、心肌梗死或糖尿病，并且在6项基本日常生活活动中需要两项或两项以上帮助的个体，发生可预防住院的风险更大。旨在减少老年人可预防住院人数的政策努力应解决那些具有特殊医疗保健需求的医疗保险受益人的复杂医疗保健提供需求，因为他们非常老，黑人，居住在核心SMSA或农村县，整体健康状况较差，并且有身体限制。努力减少经历可预防住院的医疗保险受益人的数量可能具有成本效益，因为在我们的数据集中，这些受益人可能占医疗保险住院、门诊和医生服务报销的17.4%。
OBJECTIVES. The authors examine whether the odds of having a hospitalization associated with an ambulatory care sensitive condition can be explained by observed differences in a Medicare beneficiary's predisposing, enabling, and need characteristics.METHODS. A multivariate cross-sectional analysis of Medicare's administrative inpatient claims data and the Medicare Current Beneficiary Survey was conducted on a nationally representative sample of Medicare beneficiaries. Each Medicare beneficiary's hospital utilization was classified into one of three categories: (1) no hospital admissions; (2) hospitalized, but no hospitalizations for a potentially preventable condition; and (3) at least one potentially preventable hospitalization,RESULTS. The results suggest that being older, black, or living either in a core standard metropolitan statistical area (SMSA) county or a rural county significantly increases the odds of a preventable hospitalization, whereas having attended college, or having only Medicare insurance coverage reduces the odds of a preventable hospitalization. Further, those individuals who assess their health status as poor, have had coronary heart disease, a myocardial infarction, or diabetes, and required assistance with two or more of the six basic activities of daily living are at a greater risk of a preventable hospitalization.CONCLUSIONS. Policy efforts aimed at reducing the number of preventable hospitalizations among the elderly should address the complex health care delivery needs of those Medicare beneficiaries who have special health care needs because they are very old, black, live in core SMSA or rural counties, have poor overall health status, and have physical limitations. Efforts to reduce the number of Medicare beneficiaries who experience a preventable hospitalization may be cost-effective as these beneficiaries may account for up to 17.4% of Medicare's reimbursement for inpatient, outpatient, and physician services in our data set.