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

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Title: Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias.
Authors: Burke, Laura G., Burke, Ryan C., Duggan, Ciara E., Figueroa, Jose F., Boltz, Marie, Fick, Donna M., Orav, E. John, Marcantonio, Edward R.
Source: Journal of the American Geriatrics Society. May2024, Vol. 72 Issue 5, p1442-1452. 11p.
Subjects: Medical care use, Alzheimer's disease, Research funding, Insurance, Medicare, Hospital care, Hospital emergency services, Emergency medicine, Decision making in clinical medicine, Dementia, Confidence intervals, Hospital observation units
Abstract: Background: There 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. Methods: Using 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‐). Results: Of 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). Conclusions: Medicare 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. [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 observation stays for Medicare beneficiaries with and without Alzheimer&#39;s disease and related dementias.
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– Name: Abstract
  Label: Abstract
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  Data: Background: There 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&#39;s disease and Alzheimer&#39;s disease‐related dementias (AD/ADRD) is unknown. Methods: Using 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‐). Results: Of 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 &lt; 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 &lt; 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). Conclusions: Medicare 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. [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.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/jgs.18890
    Languages:
      – Code: eng
        Text: English
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      Pagination:
        PageCount: 11
        StartPage: 1442
    Subjects:
      – SubjectFull: Medical care use
        Type: general
      – SubjectFull: Alzheimer's disease
        Type: general
      – SubjectFull: Research funding
        Type: general
      – SubjectFull: Insurance
        Type: general
      – SubjectFull: Medicare
        Type: general
      – SubjectFull: Hospital care
        Type: general
      – SubjectFull: Hospital emergency services
        Type: general
      – SubjectFull: Emergency medicine
        Type: general
      – SubjectFull: Decision making in clinical medicine
        Type: general
      – SubjectFull: Dementia
        Type: general
      – SubjectFull: Confidence intervals
        Type: general
      – SubjectFull: Hospital observation units
        Type: general
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      – TitleFull: Trends in observation stays for Medicare beneficiaries with and without Alzheimer's disease and related dementias.
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            – D: 01
              M: 05
              Text: May2024
              Type: published
              Y: 2024
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            – TitleFull: Journal of the American Geriatrics Society
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