Trends, Predictors, and Outcomes of Healthcare Resources Used in Patients Hospitalized with Alzheimer’s Disease with at Least One Procedure: The Nationwide Inpatient Sample

Abstract

We assessed trends, predictors and outcomes of resource utilization in hospital inpatient discharges with a principal diagnosis of Alzheimer's disease (AD) with at least one procedure. Using Nationwide Inpatient Sample data (NIS, 2002–2012), discharges primarily diagnosed with AD, aged ≥60 y and with ≥1 procedure, were selected (Weighted N= 92,300). Hospital resource utilization were assessed using ICD-9-CM codes, while hospitalization outcomes included total charges (TC, 2012$), length of stay (LOS, days), and mortality risk (MR, %). Brain and respiratory/gastrointestinal procedure utilization both dropped annually by 3–7%, while cardiovascular procedures/evaluations, blood evaluations, blood transfusion, and resuscitation (“CVD/Blood”) as well as neurophysiological and psychological evaluation and treatment (“Neuro”) procedures increased by 5–8%. Total charges, length of stay, and mortality risk were all markedly higher with use of respiratory/gastrointestinal procedures as opposed to being reduced with use of “Brain” procedures. Procedure count was positively associated with all three hospitalization outcomes. In sum, patterns of hospital resources that were used among AD inpatients changed over-time, and were associated with hospitalization outcomes such as total charges, length of stay, and mortality risk.

Shorter length of hospital stay for hip fracture in those with dementia and without a known diagnosis of osteoporosis in the USA

“…Our findings are contrary to most previous reports about LOS in dementia patients. Studies have reported a longer LOS for patients with dementia in the past [ 12 , 13 , 21 ], which is usually attributed to associated health complications leading to worse health status, including impaired orientation, functional abilities, and risk of fall [ 13 , 15 ]. Unlike our study, past studies have used data from patients with multiple comorbidities admitted to hospital for acute illnesses not related to hip fracture or OP.…”

“…However, women and Whites were more likely to have lower hospital charges that men and non-Whites. One study attributed higher hospital charges for inpatients with dementia due to their comorbidities complicating acute illness and a need for additional in-hospital procedures compared to the hospitalized non-dementia counterparts [ 12 ]. Having CHF or IHD posed risk to those having higher charges in our study.…”

“…Yet, these patients are often left out from rehabilitation, because they are not recognized as good candidates [7]. Discharge coordination in association with rehabilitation and destination sites are reported barriers for a longer hospital LOS [11]; dementia adds to this process by increasing LOS and hospital charges [12][13][14][15].…”

“…LOS and hospital charges for dementia patients are usually higher than those without dementia [ 12 – 14 ]. One US study has mentioned shorter LOS in patients with or without dementia after TAVR [ 19 ].…”

National Trends in Potentially Preventable Hospitalizations of Older Adults with Dementia

“…This study has several limitations. First, consistent with prior studies, we relied on hospital diagnosis coding to identify patients diagnosed with dementia; this approach underestimates the prevalence of dementia and does not provide information on severity of dementia 20,21 . Although we used diagnosis codes specific to dementia, they are not sensitive for mild cognitive impairment that frequently goes undiagnosed in outpatient settings 48 and may be misdiagnosed as delirium during hospitalization.…”