Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013

Krumholz, Harlan M.; Nuti, Sudhakar V.; Downing, Nicholas S.; Normand, Sharon‐Lise T.; Wang, Yun

doi:10.1001/jama.2015.8035

Cited by 131 publications

(110 citation statements)

References 24 publications

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“…29 This finding may be explained by recent evidence that has suggested that select low-risk PE patients may utilize outpatient care, including newer modalities of subcutaneous heparin delivery and oral anticoagulation therapy, as a safe and effective alternative to inpatient treatment. 8,9 Interestingly, despite a decrease in the length of stay, adjusted 30-day readmission rates remained fairly stable over the study period.…”

Section: Discussionmentioning

confidence: 99%

National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010)

Minges

Bikdeli

Wang

et al. 2015

The American Journal of Cardiology

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Little is known about national trends of pulmonary embolism (PE) hospitalizations and outcomes among older adults in the context of recent diagnostic and therapeutic advances. Therefore, we conducted a retrospective cohort study of 100% Medicare fee-for-service beneficiaries hospitalized between 1999 and 2010 with a principal discharge diagnosis code for PE. The adjusted PE hospitalization rate increased from 129/100,000 person-years in 1999 to 302/100,000 person-years in 2010, a relative increase of 134% (P<0.001). Black patients had the highest rate of increase (174–548/100,000 person-years) among all age-sex-race categories. The mean (SD) length-of-hospital-stay decreased from 7.6 (5.7) days in 1999 to 5.8 (4.4) days in 2010, and the proportion of patients discharged to home decreased from 51.1% (95%CI: 50.5–51.6) to 44.1% (95%CI: 43.7–44.6), while more patients were discharged with home health care and to skilled nursing facilities. The in-hospital mortality rate decreased from 8.3% (95%CI: 8.0–8.6) in 1999 to 4.4% (95%CI: 4.2–4.5) in 2010, as did adjusted 30-day (from 12.3% (95%CI: 11.9–12.6) to 9.1% (95%CI: 8.5–9.7)) and 6-month mortality rates (from 23.0% (95%CI: 22.5–23.4) to 19.6% (95%CI: 18.8–20.5)). There were no significant racial differences in mortality rates by 2010. There was no change in the adjusted 30-day all-cause readmission rate from 1999 to 2010. In conclusion, PE hospitalization rates increased substantially from 1999 to 2010, with a higher rate for Black patients. All mortality rates declined but remained high. The rise in hospitalization rates and continued high mortality and readmission rates confirm the significant burden of PE for older adults.

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Section: Discussionmentioning

confidence: 99%

National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010)

Minges

Bikdeli

Wang

et al. 2015

The American Journal of Cardiology

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“…It will be interesting to see how the "medical ecology" could be altered by technologic advances. 16 It appears that there have been gains in health outcomes among the Medicare population, 26 but gaps in health with comparator nations appear to be increasing. 6 It is also unknown to what extent the increases in expenditure are related to increased costs for treatments, drugs, and tests of similar efficacy.…”

Section: Discussionmentioning

confidence: 99%

Comparing Medical Ecology, Utilization, and Expenditures Between 1996–1997 and 2011–2012

Johansen

2017

Ann Fam Med

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PURPOSEThis study compared ecology (number of individuals using a service), utilization (number of services used), and expenditures (dollars spent) for various categories of medical services between primarily 1996-1997 and 2011-2012. METHODSA repeated cross-sectional study was performed using nationally representative data mainly from the 1996, 1997, 2011. These data were augmented with the 2002-2003 MEPS as well as the 1999-2000 and 2011-2012 National Heath and Nutrition Examination Survey. Individuals (number per 1,000 people), utilization, and expenditures during an average month in 1996-1997 and 2011-2012 were determined for 15 categories of services. RESULTSThe number of individuals who used various medical services was unchanged for many categories of services (total, outpatient, outpatient physician, users of prescribed medications, primary care and specialty physicians, inpatient hospitalization, and emergency department). It was, however, increased for others (optometry/podiatry, therapy, and alternative/complementary medicine) and decreased for a few (dental and home health). The number of services used (utilization) largely mirrored the findings for individual use, with the exception of an increase in the number of prescribed medications and a decrease in number of primary care physician visits. There were large increases in dollars spent (expenditures) in every category with the exception of primary care physician and home health; the largest absolute increases were in prescribed medications, specialty physicians, emergency department visits, and likely inpatient hospitalizations.CONCLUSIONS Although the number of individuals with visits during an average month and the total utilization of medical services were largely unchanged between the 2 time periods, total expenditures increased markedly. The increases in expenditure varied dramatically by category. Ann Fam Med 2017;15:313-321. https://doi.org/10.1370/afm.2084. INTRODUCTIONT he "Ecology of Medical Care" was initially published in 1961 1 and laid a framework for evaluating medical care in the United States. To update the estimates and to examine trends over time, this model was reevaluated in 2001 (using 1996 data) and in 2016 (using 2012 data) using more robust and systematically collected data from the Medical Expenditure Panel Survey (MEPS).2,3 Our 2016 study identified a stable proportion of individuals during an average month who sought medical care, even though the types of care individuals sought changed somewhat. 3 In contrast, medical expenditures have outpaced inflation and are notably higher than those in other developed countries on both a per capita and percent gross domestic product basis. 4 Unfortunately, these higher levels of expenditure do not correspond with better outcomes as the United States has among the worst outcomes when compared with similar nations.5 Previous studies have investigated how expenditures associated with medical care have changed over the past 50 years, 6 and more recent studies have shown that...

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“…This is particularly relevant to population health management (also known as "population medicine"), which focuses on improving the health of clinically defined groups. 4 Although the value of health care is relevant throughout the continuum of illness, costs are particularly high during the last year of life 5 -and if the value of certain interventions, such as screening for colorectal cancer, does not accrue for many years, then life expectancy should be considered when deciding to screen.…”

Section: What Population Health Can Learn From Palliative Carementioning

confidence: 99%

Why Population Health and Palliative Care Need Each Other

Casarett

Teno

2016

JAMA

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Mortality, Hospitalizations, and Expenditures for the Medicare Population Aged 65 Years or Older, 1999-2013

Cited by 131 publications

References 24 publications

National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010)

National Trends in Pulmonary Embolism Hospitalization Rates and Outcomes for Adults Aged ≥65 Years in the United States (1999 to 2010)

Comparing Medical Ecology, Utilization, and Expenditures Between 1996–1997 and 2011–2012

Why Population Health and Palliative Care Need Each Other

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