Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer's disease and related disorders
Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer's disease and related disorders
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DOI：
10.1016/j.jalz.2012.11.002
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发表时间：
2013-01-01
影响因子：
14
通讯作者：
Neumann, Peter J.
中科院分区：
文献类型：
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作者：
Lin, Pei-Jung;Fillit, Howard M.;Neumann, Peter J.
背景资料：患有阿尔茨海默病及相关疾病（ADRD）的个体比没有ADRD的个体有更频繁的住院治疗，并且其中一些入院可以通过积极的门诊护理来预防。这项研究是对195年医疗保险索赔数据的横断面分析，2007 - 2008年，从5%的医疗保险受益人随机样本中抽取了024名年龄≥ 65岁的按服务收费的ADRD受益人和相同数量的匹配的非ADRD对照。我们分析了潜在可避免的住院治疗（多环芳烃，根据老年人医疗保险门诊护理指标的定义）的患者比例，并使用逻辑回归来检查与多环芳烃相关的患者特征。我们使用配对t检验比较ADRD状态的医疗保险支出，根据是否有与特定条件相关的多环芳烃分层。结果：与匹配的非ADRD受试者相比，ADRD的医疗保险受益人更有可能因糖尿病短期并发症而患多环芳烃（OR = 1.43; 95%CI 1.31 - 1.57），糖尿病长期并发症（OR = 1.08，95%CI = 1.02-1.14），高血压（OR = 1.22; 95% CI 1.08 - 1.38），但慢性阻塞性肺疾病（COPD）/哮喘患者不太可能患有PAH（OR = 0.85; 95%CI 0.82 - 0.87）和心力衰竭（OR = 0.89; 95%CI 0.86 - 0.92）。多环芳烃的风险增加了显着的共同负担。在受益人PAH，总的医疗支出显着较高的那些科目谁也ADRD.Conclusion：医疗保险受益人ADRD是在PAH的某些不受控制的合并症的风险较高，并产生较高的医疗支出相比，匹配的控制无痴呆症。ADRD似乎使某些合并症的管理更加困难和昂贵。理想情况下，ADRD计划应该包括针对患有多种慢性疾病的高风险患者的护理管理。(C)2013年，阿尔茨海默氏症协会。All rights reserved.
Background: Individuals with Alzheimer's disease and related disorders (ADRD) have more frequent hospitalizations than individuals without ADRD, and some of these admissions may be preventable with proactive outpatient care.Methods: This study was a cross-sectional analysis of Medicare claims data from 195,024 fee-for-service ADRD beneficiaries aged >= 65 years and an equal number of matched non-ADRD controls drawn from the 5% random sample of Medicare beneficiaries in 2007-2008. We analyzed the proportion of patients with potentially avoidable hospitalizations (PAHs, as defined by the Medicare Ambulatory Care Indicators for the Elderly) and used logistic regression to examine patient characteristics associated with PAHs. We used paired t tests to compare Medicare expenditures by ADRD status, stratified by whether there were PAHs related to a particular condition.Results: Compared with matched non-ADRD subjects, Medicare beneficiaries with ADRD were significantly more likely to have PAHs for diabetes short-term complications (OR = 1.43; 95% CI 1.31-1.57), diabetes long-term complications (OR = 1.08; 95% CI = 1.02-1.14), and hypertension (OR = 1.22; 95% CI 1.08-1.38), but less likely to have PAHs for chronic obstructive pulmonary disease (COPD)/asthma (OR = 0.85; 95% CI 0.82-0.87) and heart failure (OR = 0.89; 95% CI 0.86-0.92). Risks of PAHs increased significantly with comorbidity burden. Among beneficiaries with a PAH, total Medicare expenditures were significantly higher for those subjects who also had ADRD.Conclusion: Medicare beneficiaries with ADRD were at a higher risk of PAHs for certain uncontrolled comorbidities and incurred higher Medicare expenditures compared with matched controls without dementia. ADRD appears to make the management of some comorbidities more difficult and expensive. Ideally, ADRD programs should involve care management targeting high-risk patients with multiple chronic conditions. (C) 2013 The Alzheimer's Association. All rights reserved.