Access to Primary Care for Medicare Beneficiaries

Chou, William C.; Cooney, Leo M.; Ness, Peter H. Van; Allore, Heather G.; Gill, Thomas M.

doi:10.1111/j.1532-5415.2007.01154.x

Cited by 11 publications

(7 citation statements)

References 11 publications

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“…A recent report released by the American Hospital Association examining trends in ED use by Medicare beneficiaries between 2006 to 2010 showed a number of factors contributing to this, including rising severity of illness of beneficiaries receiving ED care, greater use of ED services by people dually eligible for Medicare and Medicaid who are generally sicker with multiple chronic conditions, and increasing use of ED services by beneficiaries with behavioral health diagnoses who require higher intensity of services. 18 While the number of primary care clinics accepting Medicare remains strong, there is recent evidence to suggest that practices accepting new Medicare patients are dwindling, 19 with many patients still unable to access clinics after business hours. 20 A combination of these factors is likely contributing to the overall increasing ED visit rates for falls as well.…”

Section: Discussionmentioning

confidence: 99%

Trends and Characteristics of Emergency Department Visits for Fall-Related Injuries in Older Adults, 2003-2010

Shankar

Liu

Ganz

2017

WestJEM

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IntroductionOne third of older adults fall each year, and falls are costly to both the patient in terms of morbidity and mortality and to the health system. Given that falls are a preventable cause of injury, our objective was to understand the characteristics and trends of emergency department (ED) fall-related visits among older adults. We hypothesize that falls among older adults are increasing and examine potential factors associated with this rise, such as race, ethnicity, gender, insurance and geography.MethodsWe conducted a secondary analysis of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine fall trends over time by examining changes in ED visit rates for falls in the United States between 2003 and 2010, detailing differences by gender, sociodemographic characteristics and geographic region.ResultsBetween 2003 and 2010, the visit rate for falls and fall-related injuries among people age ≥ 65 increased from 60.4 (95% confidence interval [CI][51.9–68.8]) to 68.8 (95% CI [57.8–79.8]) per 1,000 population (p=0.03 for annual trend). Among subgroups, visits by patients aged 75–84 years increased from 56.2 to 82.1 per 1,000 (P <.01), visits by women increased from 67.4 to 81.3 (p = 0.04), visits by non-Hispanic Whites increased from 63.1 to 73.4 (p < 0.01), and visits in the South increased from 54.4 to 71.1 (p=0.03).ConclusionED visit rates for falls are increasing over time. There is a national movement to increase falls awareness and prevention. EDs are in a unique position to engage patients on future fall prevention and should consider ways they can also partake in such initiatives in a manner that is feasible and appropriate for the ED setting.

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Section: Discussionmentioning

confidence: 99%

Trends and Characteristics of Emergency Department Visits for Fall-Related Injuries in Older Adults, 2003-2010

Shankar

Liu

Ganz

2017

WestJEM

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“…Access to care for elderly Medicare beneficiaries may pose different challenges for the health care delivery system. A study found significant variations across all 4 US regions in PCPs’ willingness to accept new Medicare patients 20 . CHF is the leading cause of hospitalization for the Medicare population.…”

Section: Discussionmentioning

confidence: 99%

“…A study found significant variations across all 4 US regions in PCPs' willingness to accept new Medicare patients. 20 CHF is the leading cause of hospitalization for the Medicare population. The elderly population in the United States is projected to more than double, from approximately 12% of the US population in 2000 to 20% in 2030.…”

Section: Discussionmentioning

confidence: 99%

Ten‐Year Secular Trends for Congestive Heart Failure Hospitalizations: An Analysis of Regional Differences in the United States

Zhang

Watanabe‐Galloway

2008

Congestive Heart Failure

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This study used data from the National Hospital Discharge Survey to examine secular trends and regional variation in hospitalization rates for congestive heart failure. The hospitalization rate for congestive heart failure rose significantly between 1995 and 2004 for adults aged 35 to 64 years. This trend was particularly marked in the West region (from 10.3 per 10,000 population in 1995 to 17.0 per 10,000 population in 2004; P<.001) and the South region (from 21.9 per 10,000 population in 1995 to 27.6 per 10,000 population in 2004; P<.001). The regional variations for congestive heart failure hospitalization among adults aged 35 to 64 years were associated with primary care physicians per 10,000 population, regional income level, and the proportion of Medicare payment.

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“…Gaps in transitions in care from the inpatient to the outpatient context may account for many of the observed readmissions, especially amongst non-privately insured patients (Medicare, Medicaid, and uninsured patients) who may experience difficulty in accessing outpatient care. 12,13 …”

Section: Commentmentioning

confidence: 99%

Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention

Shah²,

et al. 2012

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Context Thirty day readmission rates have become a publicly reported quality performance measure for congestive heart failure (CHF), acute myocardial infarction (AMI), and percutaneous coronary intervention (PCI). However, little is known regarding the factors associated with 30-day readmission after PCI. Objective To assess the demographic, clinical, and procedural factors associated with 30-day readmission rates after PCI. Design, Setting, and Patients We identified 15,498 PCI hospitalizations (elective or for acute coronary syndromes) from January 1998 through June 2008 at Saint Marys Hospital, Rochester, MN. All were included in this analysis. Multivariable logistic regression models were employed to estimate the adjusted association between demographic, clinical, and procedural variables and 30-day readmission. The association between 30-day readmission and 1-year mortality was estimated using Cox proportional hazards models with readmission as a time dependent covariate and by using landmark analysis. Main Outcome Measure(s) All-cause 30-day readmission to any hospital following PCI and 1-year mortality. Results Overall, 9.4% of PCIs (n=1,459) were readmitted and 0.68% (n=106) of PCIs resulted in death within 30-days after discharge. After multivariable analysis, female sex, Medicare insurance, less than a high school education, unstable angina, cerebrovascular accident/transient ischemic attack (CVA/TIA), moderate/severe renal disease, chronic obstructive pulmonary disease (COPD), peptic ulcer disease, metastatic cancer, and a length of stay >3 days were associated with an increased risk of 30-day readmission after PCI. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality (adjusted HR=1.38; 95% CI: 1.08–1.75; p=0.009). Conclusions Nearly 1 in 10 patients undergoing PCI were readmitted within 30-days. Thirty-day readmission after PCI was associated with a higher risk of 1-year mortality.

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Access to Primary Care for Medicare Beneficiaries

Abstract: Medicare beneficiaries' access to primary care is limited and varies significantly by region, population size, and type of provider.

Cited by 11 publications

References 11 publications

Trends and Characteristics of Emergency Department Visits for Fall-Related Injuries in Older Adults, 2003-2010

Trends and Characteristics of Emergency Department Visits for Fall-Related Injuries in Older Adults, 2003-2010

Ten‐Year Secular Trends for Congestive Heart Failure Hospitalizations: An Analysis of Regional Differences in the United States

Factors Associated With 30-Day Readmission Rates After Percutaneous Coronary Intervention

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