Emergency department and inpatient utilization among US older adults with multiple chronic conditions: a post-reform update
Emergency department and inpatient utilization among US older adults with multiple chronic conditions: a post-reform update
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DOI：
10.1186/s12913-020-4902-7
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发表时间：
2020-02-03
影响因子：
2.8
通讯作者：
Smith, Matthew Lee
中科院分区：
文献类型：
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作者：
Ahn, SangNam;Hussein, Mustafa;Smith, Matthew Lee
背景《平价医疗法案》（ACA）的颁布主要是为了提高非老年人和低收入人群获得医疗服务的机会;然而，有几项规定涉及65岁以上医疗保险受益人急诊（艾德）和住院就诊的关键决定因素。我们评估了老年医疗保险受益人中这些访问的总体变化，重点关注那些患有多种慢性疾病（MCC）的人，并提供了具有全国代表性的改革后更新。我们分析了2006-2015年医疗支出小组调查（MEPS）中32，919名老年人（65岁以上）的样本。使用调查加权两部分模型，我们检查了ACA之前（2006-2010年）、期间（2011-2013年）和之后（2014-2015年）按MCC状态列出的艾德访视、住院访视和住院时间（LOS）的变化。结果在ACA之前，18.1%的医疗保险老年人有>= 1次艾德就诊，而17.1%的人有>= 1次住院就诊，平均5.1晚/次。ACA改革后，在患有2+慢性疾病的患者中，曾经有过艾德就诊的比率增加了4.3个百分点[95%置信区间[CI]：2.5，6.1，p < 0.01]，而住院就诊率下降了1.4个百分点[95%CI：-2.9，0.2，p < 0.1]，经过多变量调整。结论：我们发现，老年医疗保险受益人中，患有MCC的艾德就诊人数大幅增加，住院就诊人数显著减少，这强调了继续需要改善患有MCC的老年人的医疗服务和医疗质量，以减少对艾德的依赖，减少可预防的住院。
Background The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015). Results Prior to the ACA, 18.1% of Medicare older adults had >= 1 ED visit, whereas 17.1% had >= 1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: - 2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.