Trends in healthy days at home for Medicare beneficiaries using the emergency department.
Trends in healthy days at home for Medicare beneficiaries using the emergency department.
复制标题
使用急诊科的医疗保险受益人在家中的健康天数趋势。
DOI：
10.1111/jgs.18464
复制
发表时间：
2023
影响因子：
6.3
通讯作者：
Marcantonio,EdwardR
中科院分区：
文献类型：
--
作者：
Burke,LauraG;Burke,RyanC;Duggan,CiaraE;Figueroa,JoseF;Orav,EJohn;Marcantonio,EdwardR
背景老年人，特别是阿尔茨海默病和阿尔茨海默病相关性痴呆（AD/ADRD）患者，急诊（艾德）就诊率高，且预后差。如何最好地衡量这一人群的护理质量一直在争论。居家健康日（HDAH）是一项广泛的结局指标，反映了与在家相比，在基于机构的医疗保健环境中花费的死亡率和时间。我们检查了医疗保险受益人在访问艾德后30天HDAH的趋势，并按AD/ADRD状态比较了趋势。方法我们在2012年至2018年全国20%的68岁及以上医疗保险受益人样本中确定了所有艾德就诊。对于每次访视，我们通过减去死亡天数和艾德访视后30天内在机构医疗机构的天数计算30天HDAH。我们使用线性回归计算了HDAH的校正率，考虑了医院随机效应、就诊诊断和患者特征。我们比较了受益人之间的HDAH率与AD/ADRD，包括占疗养院（NH）residence status.ResultsWe发现较少的调整后30天HDAH后，艾德访视AD/ADRD患者相比，那些没有AD/ADRD（21.6比23.0）。这种差异是由死亡天数、SNF天数增加以及住院观察天数、艾德访视和长期住院天数减少所致。从2012年到2018年，AD/ADRD患者每年的HDAH较少，但随着时间的推移，平均年增长率更高（年份和AD/ADRD状态之间的相互作用p< 0.001）。作为一个NH居民与较少的调整后30天HDAH的受益人和没有AD/ADRD.ConclusionsBeneficiaries与AD/ADRD有较少的HDAH后艾德访问，但看到适度更大的增加HDAH随着时间的推移相比，那些没有AD/ADRD。这一趋势是由死亡率下降以及住院和急性期后护理的利用率驱动的。
BackgroundOlder adults, particularly those with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD), have high rates of emergency department (ED) visits and are at risk for poor outcomes. How best to measure quality of care for this population has been debated. Healthy Days at Home (HDAH) is a broad outcome measure reflecting mortality and time spent in facility‐based healthcare settings versus home. We examined trends in 30‐day HDAH for Medicare beneficiaries after visiting the ED and compared trends by AD/ADRD status.MethodsWe identified all ED visits among a national 20% sample of Medicare beneficiaries ages 68 and older from 2012 to 2018. For each visit, we calculated 30‐day HDAH by subtracting mortality days and days spent in facility‐based healthcare settings within 30 days of an ED visit. We calculated adjusted rates of HDAH using linear regression, accounting for hospital random effects, visit diagnosis, and patient characteristics. We compared rates of HDAH among beneficiaries with and without AD/ADRD, including accounting for nursing home (NH) residency status.ResultsWe found fewer adjusted 30‐day HDAH after ED visits among patients with AD/ADRD compared to those without AD/ADRD (21.6 vs. 23.0). This difference was driven by a greater number of mortality days, SNF days, and, to a lesser degree, hospital observation days, ED visits, and long‐term hospital days. From 2012 to 2018, individuals living with AD/ADRD had fewer HDAH each year but a greater mean annual increase over time (p< 0.001 for the interaction between year and AD/ADRD status). Being a NH resident was associated with fewer adjusted 30‐day HDAH for beneficiaries with and without AD/ADRD.ConclusionsBeneficiaries with AD/ADRD had fewer HDAH following an ED visit but saw moderately greater increases in HDAH over time compared to those without AD/ADRD. This trend was visit driven by declining mortality and utilization of inpatient and post‐acute care.