Readmission Rates and Episode Costs for Alzheimer Disease and Related Dementias Across Hospitals in a Statewide Collaborative.
Readmission Rates and Episode Costs for Alzheimer Disease and Related Dementias Across Hospitals in a Statewide Collaborative.
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DOI：
10.1001/jamanetworkopen.2023.2109
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发表时间：
2023-03-01
影响因子：
13.8
通讯作者：
Mahmoudi, Elham
中科院分区：
文献类型：
--
作者：
Kamdar, Neil;Syrjamaki, John;Aikens, James E.;Mahmoudi, Elham
阿尔茨海默病和相关痴呆症（ADRD）患者与非ADRD患者之间的再入院率和发作费用有何差异？这项队列研究的722 911住院事件发现，ADRD患者的再入院率显著高于一般老年人群（21.5% vs 14.7%）。ADRD患者的30天住院总费用也高于无ADRD患者（22 371美元vs 19 578美元），与出院后费用相关。较高的再入院率和较高的费用表明，ADRD患者应进行仔细的术前评估，以评估其是否适合内科或外科治疗，医院应更好地准备，以满足ADRD住院患者的需求。一直缺乏研究检查阿尔茨海默病和相关痴呆症（ADRD）患者在计划住院进行广泛的医疗和外科手术后再入院的风险和成本。研究密歇根州各医院ADRD患者与无ADRD患者的30天再入院率和事件成本，包括再入院成本。这项回顾性队列研究使用了2012年至2017年Michigan Value Collaborative的数据，这些数据涵盖了按ADRD诊断分层的不同医疗和手术服务。2012年1月1日至2017年6月31日期间，使用国际疾病分类第九版临床修订版确定了ADRD患者的66676次入院治疗事件（ICD-9-CM）和国际疾病统计分类，第十修订版，临床修订版（ICD-10-CM）ADRD的诊断代码，沿着656 235例无ADRD患者的入院发作。使用广义线性模型框架，本研究的风险调整，价格标准化，并进行情节支付winsorization。支付风险调整的年龄，性别，层次条件类别，保险类型，和以前的6个月付款。使用多变量逻辑回归和倾向评分匹配解释选择偏倚，无需使用卡尺进行替换。数据分析于二零一九年一月至十二月进行。存在ADRD。主要结果是患者和县一级的30天再入院率，30天再入院成本和28个医疗和外科服务的30天总发作成本。本研究纳入了722911例住院事件，其中66676例与ADRD患者相关（平均[SD]年龄，83.4 [8.6]岁; 42439例[63.6%]女性），656235例与无ADRD患者相关（平均[SD]年龄，66.0 [15.4]岁; 351246例[53.5%]女性）。倾向评分匹配后，每组共纳入58629例住院事件。ADRD患者的再入院率为21.5%（95% CI，21.2%-21.8%），无ADRD患者的再入院率为14.7%（95% CI，14.4%-15.0%）（差异，6.75个百分点; 95% CI，6.31-7.19个百分点）。ADRD患者30天再入院的成本（8378美元; 95% CI，8263 - 8494美元）比无ADRD患者（7912美元; 95% CI，7776 - 8047美元）高467美元（差异的95% CI，289 - 645美元）。在检查的所有28个服务线中，ADRD患者的30天发作总成本比无ADRD患者高2794美元（22 371美元vs 19 578美元;差异的95% CI，2668 - 2919美元）。在这项队列研究中，ADRD患者的再入院率和总再入院和发作成本高于无ADRD的患者。医院可能需要更好的设备来照顾ADRD患者，特别是在出院后。考虑到任何类型的住院治疗都可能使ADRD患者面临30天再入院的高风险，强烈建议对这一弱势患者人群进行明智的术前评估、术后出院和护理计划。这项队列研究比较了阿尔茨海默病和相关痴呆患者与非阿尔茨海默病和相关痴呆患者之间的30天再入院率、30天再入院成本和总发作成本。
What are the differences in readmission rates and episode costs between patients with Alzheimer disease and related dementias (ADRD) and patients without ADRD? This cohort study of 722 911 hospitalization episodes found that patients with ADRD had significantly higher readmission rates than the general geriatric population (21.5% vs 14.7%). The total 30-day episode cost of hospitalization was also higher among patients with ADRD than for patients without ($22 371 vs $19 578), associated with postdischarge costs. The higher readmission rates and higher costs suggest that patients with ADRD should undergo careful preoperative assessment to assess their fitness for medical or surgical treatment, and hospitals should be better prepared to address the needs of hospitalized patients with ADRD. There has been a paucity of research examining the risk and cost of readmission among patients with Alzheimer disease and related dementias (ADRD) after a planned hospitalization for a broad set of medical and surgical procedures. To examine 30-day readmission rates and episode costs, including readmission costs, for patients with ADRD compared with their counterparts without ADRD across Michigan hospitals. This retrospective cohort study used 2012 to 2017 Michigan Value Collaborative data across different medical and surgical services stratified by ADRD diagnosis. A total of 66 676 admission episodes of care that occurred between January 1, 2012, and June 31, 2017, were identified for patients with ADRD using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes for ADRD, along with 656 235 admission episodes in patients without ADRD. Using a generalized linear model framework, this study risk adjusted, price standardized, and performed episode payment winsorization. Payments were risk adjusted for age, sex, Hierarchical Condition Categories, insurance type, and prior 6-month payments. Selection bias was accounted for using multivariable logistic regression with propensity score matching without replacement using calipers. Data analysis was performed from January to December 2019. Presence of ADRD. Main outcomes were 30-day readmission rate at the patient and county levels, 30-day readmission cost, and 30-day total episode cost across 28 medical and surgical services. The study included 722 911 hospitalization episodes, of which 66 676 were related to patients with ADRD (mean [SD] age, 83.4 [8.6] years; 42 439 [63.6%] female) and 656 235 were related to patients without ADRD (mean [SD] age, 66.0 [15.4] years; 351 246 [53.5%] female). After propensity score matching, 58 629 hospitalization episodes were included for each group. Readmission rates were 21.5% (95% CI, 21.2%-21.8%) for patients with ADRD and 14.7% (95% CI, 14.4%-15.0%) for patients without ADRD (difference, 6.75 percentage points; 95% CI, 6.31-7.19 percentage points). Cost of 30-day readmission was $467 higher (95% CI of difference, $289-$645) among patients with ADRD ($8378; 95% CI, $8263-$8494) than those without ($7912; 95% CI, $7776-$8047). Across all 28 service lines examined, total 30-day episode costs were $2794 higher for patients with ADRD vs patients without ADRD ($22 371 vs $19 578; 95% CI of difference, $2668-$2919). In this cohort study, patients with ADRD had higher readmission rates and overall readmission and episode costs than their counterparts without ADRD. Hospitals may need to be better equipped to care for patients with ADRD, especially in the postdischarge period. Considering that any type of hospitalization may put patients with ADRD at a high risk of 30-day readmission, judicious preoperative assessment, postoperative discharge, and care planning are strongly advised for this vulnerable patient population. This cohort study compares 30-day readmission rates, 30-day readmission costs, and total episode costs among patients with vs without Alzheimer disease and related dementias.
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影响因子：
6.3
作者：
Callahan, Christopher M.;Tu, Wanzhu;Clark, Daniel O.
通讯作者：
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影响因子：
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DOI：
10.1016/j.apmr.2020.12.019
发表时间：
2021-06-02
影响因子：
4.3
作者：
Mahmoudi, Elham;Lin, Paul;Kamdar, Neil
通讯作者：
Kamdar, Neil
影响因子：
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