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Trends in healthy days at home for Medicare beneficiaries using the emergency department.

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Title: Trends in healthy days at home for Medicare beneficiaries using the emergency department.
Authors: Burke, Laura G., Burke, Ryan C., Duggan, Ciara E., Figueroa, Jose F., Orav, E. John, Marcantonio, Edward R.
Source: Journal of the American Geriatrics Society. Oct2023, Vol. 71 Issue 10, p3122-3133. 12p.
Subjects: Dementia, Evaluation of medical care, Hospital emergency services, Alzheimer's disease, Geriatrics, Home care services, Medical care, Regression analysis, Comparative studies, Research funding, Descriptive statistics, Medicare, Insurance, Psychology
Abstract: Background: Older adults, particularly those with Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD), have high rates of emergency department (ED) visits and are at risk for poor outcomes. How best to measure quality of care for this population has been debated. Healthy Days at Home (HDAH) is a broad outcome measure reflecting mortality and time spent in facility‐based healthcare settings versus home. We examined trends in 30‐day HDAH for Medicare beneficiaries after visiting the ED and compared trends by AD/ADRD status. Methods: We identified all ED visits among a national 20% sample of Medicare beneficiaries ages 68 and older from 2012 to 2018. For each visit, we calculated 30‐day HDAH by subtracting mortality days and days spent in facility‐based healthcare settings within 30 days of an ED visit. We calculated adjusted rates of HDAH using linear regression, accounting for hospital random effects, visit diagnosis, and patient characteristics. We compared rates of HDAH among beneficiaries with and without AD/ADRD, including accounting for nursing home (NH) residency status. Results: We found fewer adjusted 30‐day HDAH after ED visits among patients with AD/ADRD compared to those without AD/ADRD (21.6 vs. 23.0). This difference was driven by a greater number of mortality days, SNF days, and, to a lesser degree, hospital observation days, ED visits, and long‐term hospital days. From 2012 to 2018, individuals living with AD/ADRD had fewer HDAH each year but a greater mean annual increase over time (p < 0.001 for the interaction between year and AD/ADRD status). Being a NH resident was associated with fewer adjusted 30‐day HDAH for beneficiaries with and without AD/ADRD. Conclusions: Beneficiaries with AD/ADRD had fewer HDAH following an ED visit but saw moderately greater increases in HDAH over time compared to those without AD/ADRD. This trend was visit driven by declining mortality and utilization of inpatient and post‐acute care. [ABSTRACT FROM AUTHOR]
Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Trends in healthy days at home for Medicare beneficiaries using the emergency department.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Burke%2C+Laura+G%2E%22&quot;&gt;Burke, Laura G.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Burke%2C+Ryan+C%2E%22&quot;&gt;Burke, Ryan C.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Duggan%2C+Ciara+E%2E%22&quot;&gt;Duggan, Ciara E.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Figueroa%2C+Jose+F%2E%22&quot;&gt;Figueroa, Jose F.&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Orav%2C+E%2E+John%22&quot;&gt;Orav, E. John&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Marcantonio%2C+Edward+R%2E%22&quot;&gt;Marcantonio, Edward R.&lt;/searchLink&gt;
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– Name: Abstract
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  Data: Background: Older adults, particularly those with Alzheimer&#39;s Disease and Alzheimer&#39;s Disease Related Dementias (AD/ADRD), have high rates of emergency department (ED) visits and are at risk for poor outcomes. How best to measure quality of care for this population has been debated. Healthy Days at Home (HDAH) is a broad outcome measure reflecting mortality and time spent in facility‐based healthcare settings versus home. We examined trends in 30‐day HDAH for Medicare beneficiaries after visiting the ED and compared trends by AD/ADRD status. Methods: We identified all ED visits among a national 20% sample of Medicare beneficiaries ages 68 and older from 2012 to 2018. For each visit, we calculated 30‐day HDAH by subtracting mortality days and days spent in facility‐based healthcare settings within 30 days of an ED visit. We calculated adjusted rates of HDAH using linear regression, accounting for hospital random effects, visit diagnosis, and patient characteristics. We compared rates of HDAH among beneficiaries with and without AD/ADRD, including accounting for nursing home (NH) residency status. Results: We found fewer adjusted 30‐day HDAH after ED visits among patients with AD/ADRD compared to those without AD/ADRD (21.6 vs. 23.0). This difference was driven by a greater number of mortality days, SNF days, and, to a lesser degree, hospital observation days, ED visits, and long‐term hospital days. From 2012 to 2018, individuals living with AD/ADRD had fewer HDAH each year but a greater mean annual increase over time (p &lt; 0.001 for the interaction between year and AD/ADRD status). Being a NH resident was associated with fewer adjusted 30‐day HDAH for beneficiaries with and without AD/ADRD. Conclusions: Beneficiaries with AD/ADRD had fewer HDAH following an ED visit but saw moderately greater increases in HDAH over time compared to those without AD/ADRD. This trend was visit driven by declining mortality and utilization of inpatient and post‐acute care. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Journal of the American Geriatrics Society is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=pbh&AN=172913279
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/jgs.18464
    Languages:
      – Code: eng
        Text: English
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      Pagination:
        PageCount: 12
        StartPage: 3122
    Subjects:
      – SubjectFull: Dementia
        Type: general
      – SubjectFull: Evaluation of medical care
        Type: general
      – SubjectFull: Hospital emergency services
        Type: general
      – SubjectFull: Alzheimer's disease
        Type: general
      – SubjectFull: Geriatrics
        Type: general
      – SubjectFull: Home care services
        Type: general
      – SubjectFull: Medical care
        Type: general
      – SubjectFull: Regression analysis
        Type: general
      – SubjectFull: Comparative studies
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Descriptive statistics
        Type: general
      – SubjectFull: Medicare
        Type: general
      – SubjectFull: Insurance
        Type: general
      – SubjectFull: Psychology
        Type: general
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      – TitleFull: Trends in healthy days at home for Medicare beneficiaries using the emergency department.
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            NameFull: Burke, Laura G.
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            NameFull: Figueroa, Jose F.
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            NameFull: Orav, E. John
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              M: 10
              Text: Oct2023
              Type: published
              Y: 2023
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