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Lledó, Rafael; Martin, E.; Jiménez, C. Bolado; Roca, Roser; Gil, Ampar; Godoy, Elena; Trilla, Antoni; Grau, J. M.; Asenjo, Miguel A.

doi:10.1023/a:1007420911766

Cited by 12 publications

(3 citation statements)

References 15 publications

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“…There is a growing body of literature showing that neuropsychological and functional risk factors have a significant effect on health services utilization and health care costs. Multiple studies find that depression and dementia are associated with hospitalization or rehospitalization. Importantly, even mild depression and anxiety, in addition to serious mental illness, may be drivers of readmissions and costly post–acute-care utilization .…”

Section: Discussionmentioning

confidence: 99%

“…However, the TPCC measure is not adjusted for functional status and common neuropsychological comorbidities or for local area supply-side and economic condition variables. These unaccounted for patient risk factors are known to be associated with higher health care utilization and costs and are largely outside of outpatient clinicians’ control.…”

Section: Introductionmentioning

confidence: 99%

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Association Between Patient Cognitive and Functional Status and Medicare Total Annual Cost of Care

et al. 2018

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IMPORTANCE Medicare is moving toward value-based payment. The Merit-Based Incentive Payment System (MIPS) program judges outpatient clinicians' performance on a measure of annual Medicare spending. However, this measure may disadvantage outpatient clinicians who care for vulnerable populations because the algorithm omits meaningful determinants of cost. OBJECTIVES To determine whether factors not included in Medicare risk adjustment, including patient neuropsychological and functional status, as well as local area health resources and economic conditions, are associated with Medicare total annual cost of care (TACC), and evaluate whether accounting for these factors is associated with improved TACC performance by outpatient safety-net clinicians. DESIGN, SETTING, AND PARTICIPANTS In this retrospective observational study, we used the Medicare Current Beneficiary Survey (MCBS) to examine patient-reported neuropsychological and functional status and the Area Health Resources File to obtain information on local area characteristics. Included were Medicare beneficiaries with annual physician or clinic visits to outpatient safety-net (federally qualified health centers and rural health clinics) and non-safety-net clinics, contributing 76 927 person-years of data to the MCBS from 2006 through 2013. We used patient-level multivariable regression models to estimate the association between each factor and annual Medicare spending, and compared outpatient safety-net performance under current risk adjustment and after adding additional adjustment for these factors. MAIN OUTCOMES AND MEASURES Medicare TACC, measured as the total annual reimbursed amount per patient for Medicare Part A and Part B services, in all categories. RESULTS Our study included 111 414 unique identifiable physicians, and the final weighted sample included 213 904 324 patient-years (unweighted, 76 927 patient-years) from 30 058 unique patients, of whom 17 478 (58.1%) were women. The mean (SD) patient age was 71.84

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association Between Patient Cognitive and Functional Status and Medicare Total Annual Cost of Care

et al. 2018

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“…A significant percentage of patients with dementia are admitted to hospital for intercurrent acute diseases, even in the advanced stage of the disease [2]. Among subjects discharged from general hospitals, the percentage of patient with dementia vary between 4 and 30% [2][3][4][5][6]. It has been reported that dementia is generally associated with higher rate of admission to hospital, increased length of hospitalization, and with an increased risk in post-admission mortality, both in-hospital and on medium to long terms [2,5,[7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Dementia and in-hospital mortality: retrospective analysis of a nationwide administrative database of elderly subjects in Italy

et al. 2021

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Aims To evaluate the relationship between comorbidity and in-hospital mortality in elderly patients affected by dementia. Methods Data were obtained from the Italian Ministry of Health and included all discharge records from Italian hospitals concerning subjects aged ≥ 65 years admitted to acute Internal Medicine or Geriatrics wards between January 2015 and December 2016 (3.695.278 admissions). The variables analyzed included age, sex, and in-hospital death. Twenty-five homogeneous clusters of diseases were identified in discharge codes according to the ICD-9-CM classification. Results Patients with dementia represented 7.5% of the sample (n. 278.149); they were older, more often males (51.9%), and had a higher in-hospital mortality (24.3%) compared to patients without dementia (9.7%). Dementia per se doubled the odds of death (OR 1.98; 95% CI 1.95-2.00), independent of age, sex, and comorbidities. Seven clusters of disease (pneumonia, heart failure, kidneys disease, cancer, infectious diseases, diseases of fluids/electrolytes and general symptoms) were associated with increased in-hospital mortality, independent of the presence/absence of dementia. Among patients with dementia, heart failure, pneumonia and kidney disease on their own substantially doubled/tripled mortality risk. The risk increased from 10.1% (none of selected conditions), up to 28.9% when only one of selected comorbidities was present, rising to 52.3% (OR: 9.34; p < 0.001) when two or more comorbidities were simultaneously diagnosed, besides general symptoms. Conclusions Our study confirmed an important increase of in-hospital mortality in older subjects with dementia. Despite a different comorbidity, the conditions associated with in-hospital mortality were substantially the same in patients with or without dementia. Heart failure, pneumonia, and kidney disease identified a high risk of in-hospital mortality among subjects with dementia.

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Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia

Zuliani

Galvani

Sioulis

et al. 2011

Int J Geriat Psychiatry

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Among older patients, dementia was associated with higher rate of admissions to hospital and mortality. Discharge diagnoses were sensibly different according to the presence of dementia; in particular, a greater load and a different kind of comorbidity were observed in demented patients. On the whole, our data suggest that the adequate management of demented outpatients might help to reduce hospitalization.

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Untitled

Cited by 12 publications

References 15 publications

Association Between Patient Cognitive and Functional Status and Medicare Total Annual Cost of Care

Association Between Patient Cognitive and Functional Status and Medicare Total Annual Cost of Care

Dementia and in-hospital mortality: retrospective analysis of a nationwide administrative database of elderly subjects in Italy

Discharge diagnosis and comorbidity profile in hospitalized older patients with dementia

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