Noncardiac comorbidities are highly prevalent in older patients with CHF and strongly associate with adverse clinical outcomes. Cardiologists and other providers routinely caring for older patients with CHF may improve outcomes in this high-risk population by better recognizing non-CHF conditions, which may complicate traditional CHF management strategies.

In a nationally representative sample, higher Medicare expenditures associated with a diagnosis of dementia are in large part due to increased hospitalization. Further study is needed into the factors associated with high rates of hospitalization in dementia patients including aspects of ambulatory management that may be improved.

Although long-term care receives far less U.S. policy attention than health care does, long-term care matters to many Americans of all ages and affects spending by public programs. Problems in the current long-term care system abound, ranging from unmet needs and catastrophic burdens among the impaired population to controversies between state and federal governments about who bears responsibility for meeting them. As the population ages, the pressure to improve the system will grow, raising key policy issues that include the balance between institutional and noninstitutional care, assurance of high-quality care, the integration of acute and long-term care, and financing mechanisms to provide affordable protection.

OBJECTIVE -To examine the impact of comorbid conditions on preventable hospitalizations among Medicare beneficiaries aged Ն65 years with type 2 diabetes.RESEARCH DESIGN AND METHODS -Data were drawn from the 1999 Medicare Standard Analytic Files, a 5% nationally representative random sample of Medicare beneficiaries. The analysis sample included 193,556 Medicare beneficiaries aged Ն65 years with type 2 diabetes (ICD-9-CM codes 250.xx) who were enrolled in fee-for-service Medicare. Preventable hospitalization was assessed by measuring ambulatory care-sensitive conditions, an accepted measure of hospitalizations that could have been prevented with appropriate outpatient care. Multivariable analyses controlled for demographics; mortality; renal, ophthalmic, or neurological manifestations of diabetes; type of physician providing the outpatient care; and per capita community-level indicators of income and hospital beds.RESULTS -Ninety-six percent of beneficiaries in the sample had a comorbidity, and 46% had five or more comorbidities. Among beneficiaries with type 2 diabetes, cardiovascular-related comorbidities were common and accounted for increased odds of preventable hospitalization, controlling for other factors. The likelihood of a preventable hospitalization increased in the presence of a claim for comorbid congestive heart failure, cardiomyopathy, coronary atherosclerosis, hypertension, or cardiac dysrythmias. Noncardiovascular comorbidities associated with a greater likelihood of preventable hospitalization included chronic obstructive pulmonary disease, asthma and lower respiratory disorders, Alzheimer's disease/dementia, personality/anxiety disorders, depression, and osteoporosis. Our data suggest that nearly 7% of all hospitalizations could be avoided.CONCLUSIONS -These findings support the need for improved outpatient care strategies to reduce the impact of comorbidity on unnecessary hospitalization in patients aged Ն65 years with type 2 diabetes. Diabetes Care 26:1344 -1349, 2003T ype 2 diabetes is a major cause of morbidity and mortality. Diabetes complicates the diagnosis and treatment of other medical disorders, particularly in an elderly population already burdened by extensive comorbidity (1). For instance, both diabetes and older age can mask the typical manifestations of cardiac ischemia (2-4). Elderly patients with diabetes have more extensive atherosclerosis (5), experience worse clinical outcomes after revascularization (6 -11), and are two to four times more likely to die from cardiovascular disease (CVD) than elderly patients without diabetes (12-15). Appropriate management of subjects with type 2 diabetes and other comorbidities may differ substantially from the management of those without comorbidities (16 -18). Individuals with diabetes and concomitant comorbidities are at an increased risk of using greater resources by requiring more hospitalizations, longer hospital stays, and more expensive services (12,19 -21).Despite knowledge regarding interactions between diabetes and specific comor...