Adverse Events and Hospital-Acquired Conditions Associated With Potential Low-Value Care in Medicare Beneficiaries

Chalmers, Kelsey; Gopinath, Valérie; Brownlee, Shannon; Saini, Vikas; Elshaug, Adam G

doi:10.1001/jamahealthforum.2021.1719

Cited by 7 publications

(4 citation statements)

References 28 publications

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“…Recently published studies examined the downstream effects of low-value care procedures in hospitals. They revealed that patients who received low-value care were associated with higher Medicare costs and longer lengths of stay [ 40 , 41 ], which is in line with the results of our analysis, demonstrating that PwD who received Lvm treatments were more frequently hospitalized (39 vs 26%) and stayed longer in hospitals (6 vs 3 days). The higher utilization of in-hospital services resulted in higher inpatient treatment costs (4501 € vs 2380 €) compared with PwD without Lvm treatments.…”

Section: Discussionsupporting

confidence: 90%

Associations Between Low-Value Medication in Dementia and Healthcare Costs

et al. 2022

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Background Low-value medications (Lvm) provide little or no benefit to patients, may be harmful, and waste healthcare resources and costs. Although evidence from the literature indicates that Lvm is highly prevalent in dementia, evidence about the financial consequences of Lvm in dementia is limited. This study analyzed the association between receiving Lvm and healthcare costs from a public payers’ perspective. Methods This analysis is based on data of 516 community-dwelling people living with dementia (PwD). Fourteen Lvm were extracted from dementia-specific guidelines, the German equivalent of the Choosing Wisely campaign, and the PRISCUS list. Healthcare utilization was retrospectively assessed via face-to-face interviews with caregivers and monetarized by standardized unit costs. Associations between Lvm and healthcare costs were analyzed using multiple linear regression models. Results Every third patient ( n = 159, 31%) received Lvm. Low-value antiphlogistics, analgesics, anti-dementia drugs, sedatives and hypnotics, and antidepressants alone accounted for 77% of prescribed Lvm. PwD who received Lvm were significantly less cognitively impaired than those not receiving Lvm. Receiving Lvm was associated with higher medical care costs ( b = 2959 €; 95% CI 1136–4783; p = 0.001), particularly due to higher hospitalization ( b = 1911 €; 95% CI 376–3443; p = 0.015) and medication costs ( b = 905 €; 95% CI 454–1357; p < 0.001). Conclusion Lvm were prevalent, more likely occurring in the early stages of dementia, and cause financial harm for payers due to higher direct medical care costs. Further research is required to derive measures to prevent cost-driving Lvm in primary care, that is, implementing deprescribing interventions and moving health expenditures towards higher value resource use.

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Section: Discussionsupporting

confidence: 90%

Associations Between Low-Value Medication in Dementia and Healthcare Costs

et al. 2022

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“…Recently published studies examined the downstream effects of low-value care procedures in hospitals. They revealed that patients who received low-value care were associated with higher Medicare costs and longer lengths of stay [40,41], which is in line with the results of our analysis, demonstrating that PwD who received Lvm treatments were more frequently hospitalized (39 vs 26%) and stayed longer in hospitals (6 vs 3 days). The higher utilization of in-hospital services resulted in higher inpatient treatment costs (4501 € vs 2380 €) compared with PwD without Lvm treatments.…”

Section: Discussionsupporting

confidence: 89%

Associations between Low‐value Medication in Dementia and Healthcare Costs

Platen

Hoffmann

Michalowsky

2022

Alzheimer's & Dementia

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BackgroundLow‐value medication (Lvm) provides little or no benefit to patients may be harmful and wastes healthcare resources. However, there is evidence from the literature that Lvm is highly prevalent in age‐associated mental illnesses, such as dementia. Evidence about the financial consequences of Lvm among people living with dementia (PwD) is limited. This study analyzed the association between receiving Lvm and healthcare costs from a payers’ perspective.MethodThis analysis is based on data of 516 community‐dwelling PwD. In total, 14 Lvm were extracted from 1) dementia‐specific guidelines, 2) the German equivalent of the Choosing Wisely campaign, and 3) the PRISCUS list. Healthcare utilization was retrospectively assessed via face‐to‐face interviews with PwD, caregivers, and professional care staff and monetarized by standardized unit costs to calculate costs from a payer perspective. Associations between Lvm and healthcare costs were analyzed using multiple linear regression models.ResultEvery third person living with dementia (n = 159, 31%) received Lvm. PwD who received Lvm were less cognitively impaired (Mini Mental State 23.0 vs. 21.7, p = 0.013). To receive Lvm was associated with higher medical care costs (b = 2,520€; CI95% 1,252€ – 3,788€, p< 0.001), particularly due to higher prevalence of in‐hospital treatment (b = 1,576€; CI95% 424€ – 2,728€, p = 0.007) and higher cost for medication (b = 784€; CI95% 466€ – 1,101€, p< 0.001).ConclusionLvm was very prevalent, more likely to occur in the early stages of dementia and can cause financial harm for payers due to higher costs for in‐hospital care and medications. Further research is required to derive measures to prevent cost‐driving Lvm in primary care and move health expenditures towards higher‐value resource use.

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“…The extent and number of LVPs and their economic impact have been studied for years in various countries and healthcare levels [ 10 , 35 , 36 ]. Some recent studies have emerged identifying the impact of LVPs in terms of patient safety, linking LVPs to the occurrence of preventable adverse events [ 37 ].…”

Section: Discussionmentioning

confidence: 99%

Gender Disparities in Adverse Events Resulting From Low-Value Practices in Family Practice in Spain: A Retrospective Cohort Study

Mira,

Carratala-Munuera,

Vicente

et al. 2024

Int J Public Health

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Objectives: This study aimed to evaluate gender-based disparities in preventable adverse events due to low-value practices (LVPs) in primary care.Methods: A retrospective cohort study in Alicante, Spain.Results: A total of 1,516 patient records were examined, finding that older individuals and women experienced more LVP-related events. Female patients faced a higher volume of such events than males with the same health issue. Interaction analysis revealed patients treated by male physicians had more severe events, while those attended by females experienced milder ones. Adverse events were more frequent in LVPs associated with gender-based reasons.Conclusion: These results highlight the need for tailored healthcare professional awareness programs on overuse’s impact on safety. Addressing outcome differences between male and female patients should inform awareness campaigns.

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Adverse Events and Hospital-Acquired Conditions Associated With Potential Low-Value Care in Medicare Beneficiaries

Cited by 7 publications

References 28 publications

Associations Between Low-Value Medication in Dementia and Healthcare Costs

Associations Between Low-Value Medication in Dementia and Healthcare Costs

Associations between Low‐value Medication in Dementia and Healthcare Costs

Gender Disparities in Adverse Events Resulting From Low-Value Practices in Family Practice in Spain: A Retrospective Cohort Study

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