Disparities in 30‐day readmission rates among Medicare enrollees with dementia

Gilmore‐Bykovskyi, Andrea; Zuelsdorff, Megan; Block, Laura; Golden, Blair P.; Kaiksow, Farah; Sheehy, Ann M.; Bartels, Christie M.; Kind, Amy J H; Powell, W. Ryan

doi:10.1111/jgs.18311

Cited by 11 publications

(24 citation statements)

References 70 publications

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“…All of these potential adverse consequences of observation stays for people with AD/ADRD have implications for health equity, given prior work showing that Black patients and people residing in communities with greater social disadvantage have both greater exposure to observation 21,29 as well as higher prevalence of AD/ADRD 35–37 . Thus, there are likely multiple reinforcing mechanisms underlying racial and socioeconomic disparities in acute care delivery and outcomes, as has been noted for hospital readmissions in the population of Medicare beneficiaries with dementia 38 …”

Section: Discussionmentioning

confidence: 99%

Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias

Burke,

Duggan

et al. 2024

J American Geriatrics Society

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BackgroundThere has been a marked rise in the use of observation care for Medicare beneficiaries visiting the emergency department (ED) in recent years. Whether trends in observation use differ for people with Alzheimer's disease and Alzheimer's disease‐related dementias (AD/ADRD) is unknown.MethodsUsing a national 20% sample of Medicare beneficiaries ages 68+ from 2012 to 2018, we compared trends in ED visits and observation stays by AD/ADRD status for beneficiaries visiting the ED. We then examined the degree to which trends differed by nursing home (NH) residency status, assigning beneficiaries to four groups: AD/ADRD residing in NH (AD/ADRD+ NH+), AD/ADRD not residing in NH (AD/ADRD+ NH‐), no AD/ADRD residing in NH (AD/ADRD‐ NH+), and no AD/ADRD not residing in NH (AD/ADRD‐ NH‐).ResultsOf 7,489,780 unique beneficiaries, 18.6% had an AD/ADRD diagnosis. Beneficiaries with AD/ADRD had more than double the number of ED visits per 1000 in all years compared to those without AD/ADRD and saw a faster adjusted increase over time (+26.7 vs. +8.2 visits/year; p < 0.001 for interaction). The annual increase in the adjusted proportion of ED visits ending in observation was also greater among people with AD/ADRD (+0.78%/year, 95% CI 0.77–0.80%) compared to those without AD/ADRD (+0.63%/year, 95% CI 0.59–0.66%; p < 0.001 for interaction). Observation utilization was greatest for the AD/ADRD+ NH+ population and lowest for the AD/ADRD‐ NH‐ population, but the AD/ADRD+ NH‐ group saw the greatest increase in observation stays over time (+15.4 stays per 1000 people per year, 95% CI 15.0–15.7).ConclusionsMedicare beneficiaries with AD/ADRD have seen a disproportionate increase in observation utilization in recent years, driven by both an increase in ED visits and an increase in the proportion of ED visits ending in observation.

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Section: Discussionmentioning

confidence: 99%

Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias

Burke,

Duggan

et al. 2024

J American Geriatrics Society

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“…A total of 7,194,878 participants were included in this review. The high number of participants is explained by the fact that large hospital and insurance records were used in 15 out of 17 studies [17-19, 42-45, 47-52, 54, 55], with three studies each having over 1.5 million participants [18,50,55]. The studies were undertaken in eight countries: one in Taiwan [42], nine in the USA [43-46, 48-50, 52, 53], one in Australia [51], and one each in Canada [17], Sweden [54], Japan [18], the Netherlands [19], and Denmark [47].…”

Section: Study Characteristicsmentioning

confidence: 99%

Determinants of hospital readmissions in older people with dementia: A narrative review

Browne,

Ali,

Ford

et al. 2023

Preprint

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Introduction Over 50% of hospitalised older people with dementia have multimorbidity, and are at an increased risk of hospital readmission within 30 days from discharge. Between 20-40% of these readmissions may be preventable. Current research focuses on the physical causes of readmissions. However, older people with dementia have additional psychosocial factors that are likely to increase the risk of readmissions. This narrative review aimed to identify psychosocial determinants for hospital readmissions, within the context of known physical factors. Methods Electronic databases MEDLINE, EMBASE, CINAHL and PsychInfo were searched from inception until July 2022. Quantitative and qualitative studies in English including adults aged 65 years and over with dementia, their care workers and informal carers were considered if they investigated hospital readmissions. An inductive approach was adopted to map the determinants of readmissions. Identified themes were described as narrative categories. Results Sixteen studies including 7,194,878 participants met our inclusion criteria from a total of 4736 articles. Fifteen quantitative studies included observational cohorts and randomised controlled trial designs, and one study was qualitative. Nine studies were based in the USA, and one study each from Taiwan, Australia, Canada, Sweden, Japan, Denmark, and The Netherlands. Large hospital and insurance records provided data on over 2 million patients in one American study. Physical determinants included reduced mobility and accumulation of long-term conditions. However, identified psychosocial determinants were restricted to inadequate hospital discharge planning, limited interdisciplinary collaboration, and socioeconomic inequalities among ethnic minorities. Other important psychosocial factors such as loneliness, poverty and mental well-being, were not included in the studies. Conclusion Poorly defined roles and responsibilities of health and social care professionals and poor communication during care transitions increase the risk of readmission in older people with dementia. These identified psychosocial determinants are likely to significantly contribute to readmissions. Frequent use of antipsychotic medications might also explain the interplay between physical and psychosocial determinants. However, future research should also focus on the understanding of the interaction between a host of psychosocial and physical determinants, and multidisciplinary interventions across care settings to reduce hospital readmissions.

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“…Older patients from ethnic minorities face numerous barriers to care that have negative effects on their treatment outcomes (Conner et al, 2021). Therefore, this population has a higher risk of readmission after hospitalization than their native counterparts (Anderson et al, 2022; Gilmore‐Bykovskyi et al, 2023; Rayan‐Gharra et al, 2019); indeed, in some cases, the rate of re‐hospitalization nearly doubles in older adults with dementia (Gilmore‐Bykovskyi et al, 2023). Identifying effective strategies to improve care transitions is essential for managing older adults' healthcare needs after hospital discharge to prevent poor outcomes (Hirschman et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Transitional care of older ethnic minority patients: An integrative review

Dolu

Hayter

Serrant

2023

Journal of Advanced Nursing

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AimsTo critically synthesize the empirical literature on practice in transitional care and how to meet the care needs of older ethnic minority populations who discharged from hospital to community.DesignAn integrative literature review integrating empirical studies using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines.Data SourcesPubMed, Web of Science, PsycINFO, EBSCO (including CINAHL and MEDLINE) and Scopus were searched for papers published between 2012 and September 2022.Review MethodsFull‐text papers were screened against inclusion and exclusion criteria subsequent to screening titles and abstracts. All included papers were evaluated for methodological quality using the Critical Appraisal Skills Programme Checklists. After extracting findings, themes were created by critically examining and synthesizing of findings.ResultsThe search yielded a total of 1180 studies, 1153 after removing duplicates and 27 papers meeting the inclusion criteria and exclusion criteria were included in the review. The main findings were categorized into four themes: (i) intervention‐related outcomes; (ii) unmet needs of older minority people; (iii) transitional care–related characteristics of older minority people and (iv) challenges for healthcare providers. Findings indicated that the transitional care experience of ethnic minority older populations differed from natives to some extent which revealed unmet needs addressing how to provide culturally appropriate transitional care for this population.ConclusionThis review gave insight into facilitators in the transitional care of ethnic minority older adults. Future transitional care interventions should incorporate needs of ethnic minority population.ImpactThis review highlighted the defined gaps between existing transitional care programmes and transitional care needs of older ethnic minority. Increasing follow‐up completion, evidence defining deeply of ethnic phenomenon in the transitional care process, developing interventions that meet transitional care needs and increasing healthcare providers' cultural competency were featured headlines.No Patient or Public Contribution.

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Disparities in 30‐day readmission rates among Medicare enrollees with dementia

Cited by 11 publications

References 70 publications

Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias

Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias

Determinants of hospital readmissions in older people with dementia: A narrative review

Transitional care of older ethnic minority patients: An integrative review

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