Medicare Expenditures Associated With Hospital and Emergency Department Use Among Beneficiaries With Dementia

Daras, Laura Coots; Feng, Zhanlian; Wiener, Joshua M.; Kaganova, Yevgeniya

doi:10.1177/0046958017696757

Cited by 25 publications

(34 citation statements)

References 36 publications

(64 reference statements)

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“…Contrary to our expectations and similar to other previous studies (21,64), the argument of rising medical costs resulting from living in NH was not confirmed in the RTPC sample. It was observed that medical costs associated with hospital admission (including EDA) were lower in the NH setting.…”

Section: Discussioncontrasting

confidence: 99%

Hospital transfer of people with dementia: results of the European RightTimePlaceCare project on their frequency, factors associated and costs

Afonso-Argilés¹,

Meyer²,

Stephan³

et al. 2020

Preprint

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Background Hospitalisation is a critical moment for people with dementia and a major challenge for health care systems. The aims of this study were 1) to describe the frequency of hospital transfer among people with dementia from eight European countries, 2) to examine the factors associated with hospital transfer and 3) to evaluate the costs related with it. Methods The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was carried out with data collected from people with dementia who lived either at home or had been admitted to a nursing home in the last three months, as well as from their caregivers. Data on hospital transfers at three months were gathered with the "The Resource Utilization in Dementia" instrument. Demographic data, functional, cognitive and neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status and falls were evaluated with validated tools. Multivariate regression models were used to investigate the factors associated with hospital transfers. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2018. Results The study sample comprised 1,700 people with dementia and their informal caregivers. Within three months, 16.7% experienced ≥ 1 hospital transfers. Multivariate logistic regression model showed a higher probability of hospital transfers among people with dementia with unintentional weight loss, polypharmacy, falls and those living in the community. The estimated costs per person with dementia/year among the participants living in a nursing home were 980.56 euros and 2,535.39 euros among those receiving home care. Conclusion Transfer to hospital is frequent among people with dementia, especially among those living in the community. These events are associated with the onset of geriatric syndromes such as involuntary weight loss, accidental falls and polypharmacy, and impose a remarkable economic burden. These results suggest that there is a need to develop and implement cost-effective supportive interventions that focus on the identification of people with dementia at risk of hospital transfer, the assessment and management of these geriatric syndromes and the promotion of individualised care planning for them, in order to prevent unnecessary hospital transfers.

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Section: Discussioncontrasting

confidence: 99%

Hospital transfer of people with dementia: results of the European RightTimePlaceCare project on their frequency, factors associated and costs

Afonso-Argilés¹,

Meyer²,

Stephan³

et al. 2020

Preprint

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“…Similar to our results, Coots Daras et al (2017) found that people with dementia in their last year of life living in NH had lower costs derived of EDA and HA than people with dementia living in the community. However, these results were not seen among the general population with dementia, for whom the costs of EDA and HA were higher among those living in NH (16). The authors discuss that expenditures associated with hospital and ED use may vary by residential setting, and proximity to death.…”

Section: Insert Table 6 Discussionmentioning

confidence: 79%

Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs

Afonso-Argilés

Meyer

Stephan

et al. 2020

Preprint

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Background: Evidence is lacking on the differences between hospitalisation of people with dementia living in nursing homes and those living in the community. The objectives of this study were: 1) to describe the frequency of hospital admission among people with dementia in eight European countries living in nursing homes or in the community, 2) to examine the factors associated with hospitalisation in each setting, and 3) to evaluate the costs associated with it.Methods: The present study is a secondary data analysis of the RightTimePlaceCare European project. A cross-sectional survey was conducted with data collected from people with dementia living at home or who had been admitted to a nursing home in the last three months, as well as from their caregivers. Data on hospital admissions at three months, cognitive and functional status, neuropsychiatric symptoms, comorbidity, polypharmacy, caregiver burden, nutritional status, and falls were assessed using validated instruments. Multivariate regression models were used to investigate the factors associated with hospital admission for each setting. Costs were estimated by multiplying quantities of resources used with the unit cost of each resource and inflated to the year 2019.Results: The study sample comprised 1,700 people with dementia living in the community and nursing homes. Within three months, 13.8% and 18.5% of people living in nursing homes and home care, respectively, experienced ≥1 hospital admission. In the nursing home setting, only polypharmacy was associated with a higher chance of hospital admission, while in the home care setting, unintentional weight loss, polypharmacy, falls, and more severe caregiver burden were associated with hospital admission. Overall, the estimated average costs per person with dementia/year among participants living in a nursing home were lower than those receiving home care.Conclusion: Admission to hospital is frequent among people with dementia, especially among those living in the community, and seems to impose a remarkable economic burden. The identification and establishment of an individualised care plan for those people with dementia with polypharmacy in nursing homes, and those with involuntary weight loss, accidental falls, polypharmacy and higher caregiver burden in the home care setting, might help preventing unnecessary hospital admissions.

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“…These conditions may increase the cost of medical care for patients with dementia. The annual mean costs of emergency department Medicare expenditures among patients with dementia were higher than those among patients without dementia (Daras et al, 2017).…”

Section: Introductionmentioning

confidence: 81%

Primary diagnoses and outcomes of emergency department visits in older people with dementia: a hospital-based retrospective study in Taiwan

Lin

Hsieh

et al. 2019

Int. Psychogeriatr.

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Objectives:The objectives of this study were to investigate the primary diagnoses and outcomes of emergency department visits in older people with dementia and to compare these parameters with those in older adults without dementia.Design and Setting:This hospital-based retrospective study retrieved patient records from a hospital research database, which included the outpatient and inpatient claims of two hospitals.Participants:The patient records were retrieved from the two hospitals in an urban setting. The inclusion criteria were all patients aged 65 and older who had attended the two hospitals as an outpatient or inpatient between January 1, 2009, and December 31, 2016. Patients with dementia were identified to have at least three reports of diagnostic codes, either during outpatient visits, during emergency department visits, or in hospitalized database records. The other patients were categorized as patients without dementia.Measurements:The primary diagnosis during the emergency department visit, cost of emergency department treatment, cost of hospital admission, length of hospital stay, and diagnosis of death were collected.Results:A total of 149,203 outpatients and inpatients aged 65 and older who were admitted to the two hospitals were retrieved. The rate of emergency department visits in patients with dementia (23.2%) was lower than that in those without dementia (48.6%). The most frequent primary reason for emergency department visits and the main cause of patient death was pneumonia. Patients with dementia in the emergency department had higher hospital admission rates and longer hospital stays; however, the cost of treatment did not show a significant difference between the two groups.Conclusions:Future large and prospective studies should explore the severity of disease in older people with dementia and compare results with older adults without dementia in the emergency department.

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Medicare Expenditures Associated With Hospital and Emergency Department Use Among Beneficiaries With Dementia

Cited by 25 publications

References 36 publications

Hospital transfer of people with dementia: results of the European RightTimePlaceCare project on their frequency, factors associated and costs

Hospital transfer of people with dementia: results of the European RightTimePlaceCare project on their frequency, factors associated and costs

Emergency department and hospital admissions among people with dementia living at home or in nursing homes: results of the European RightTimePlaceCare project on their frequency, associated factors and costs

Primary diagnoses and outcomes of emergency department visits in older people with dementia: a hospital-based retrospective study in Taiwan

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