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Predictors of avoidable hospitalizations among assisted living residents.
- Source :
-
Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2012 May; Vol. 13 (4), pp. 355-9. Date of Electronic Publication: 2011 Mar 12. - Publication Year :
- 2012
-
Abstract
- Objectives: Hospitalizations for long term care residents, including those from assisted living facilities (ALFs), are very costly, often traumatic, and increase risk for iatrogenic disorders for those involved. Currently, hospital expenditures account for approximately one-third of total national health care spending. Hospitalizations for ambulatory care-sensitive (ACS) conditions are considered potentially avoidable, as these are physical health conditions that can often be treated safely at a lower level of care or occur as a result of lack of timely, adequate treatment at a lower level of care. The goal was to examine risk factors for hospitalization for an ACS condition of Medicaid-enrolled younger and older ALF residents during 2003-2008.<br />Design: This is a retrospective cohort study that used 5 years of Medicaid enrollment and fee-for-service claims data.<br />Participants: The study sample included 16,208 Medicaid-enrolled ALF residents in Florida, 7991 (49%) of whom were 65 years of age or older.<br />Results: In total, study participants had 22,114 hospitalizations, 3759 (17%) of which were for an ACS condition. Sixteen percent of all ALF residents (n = 2587), about 12% of the younger residents and 20% of the older residents, had at least one ACS hospitalization. ACS hospitalizations constitute 13% of all hospitalizations for the younger residents and 22% of all hospitalizations for the older residents. Using Cox proportional hazard regression, we found that for both age groups, increased age, being Hispanic or of other race/ethnicity, and having comorbid physical health conditions were associated with a higher risk of ACS hospitalization. For older residents, having a dementia diagnosis and being African American reduced the risk of ACS hospitalization, whereas for younger residents having a major psychotic disorder reduced the risk of ACS hospitalization.<br />Conclusion: The results highlight the need for increased education, communication, and future research on these predictive factors. The increased frequency of hospitalization for ACS conditions among ALF residents with minority status and older age may well indicate that their more complex health care needs are not being adequately addressed. The role of serious mental illness and dementia in risk for ACS hospitalization also deserves further attention.<br /> (Copyright © 2012 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Age Factors
Aged
Aged, 80 and over
Cohort Studies
Confidence Intervals
Databases, Factual
Ethnicity statistics & numerical data
Female
Geriatric Assessment methods
Health Status Indicators
Hospitalization economics
Humans
Long-Term Care
Male
Middle Aged
Predictive Value of Tests
Primary Prevention organization & administration
Proportional Hazards Models
Quality of Health Care
Retrospective Studies
Risk Factors
Socioeconomic Factors
Stress, Psychological
United States
Ambulatory Care statistics & numerical data
Assisted Living Facilities statistics & numerical data
Hospitalization statistics & numerical data
Medicaid statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1538-9375
- Volume :
- 13
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of the American Medical Directors Association
- Publication Type :
- Academic Journal
- Accession number :
- 21450253
- Full Text :
- https://doi.org/10.1016/j.jamda.2011.02.001