Preventable hospitalizations, barriers to care, and disability. Medicine (Baltimore) 2018 May;97(19):e0691
Date
05/10/2018Pubmed ID
29742717Pubmed Central ID
PMC5959443DOI
10.1097/MD.0000000000010691Scopus ID
2-s2.0-85046987329 (requires institutional sign-in at Scopus site) 11 CitationsAbstract
The AHRQ's Prevention Quality Indicators assume inpatient hospitalizations for certain conditions, referred as ambulatory-care sensitive (ACS) conditions, are potentially preventable and may indicate reduced access to and a lower quality of ambulatory care. Using a cohort drawn from the Medicare Current Beneficiary Survey (MCBS) linked to Medicare claims, we examined the extent to which barriers to healthcare are associated with ACS hospitalizations and related costs, and whether these associations differ by beneficiaries' disability status. Our results indicate that the regression-adjusted cost of ACS hospitalizations for elderly Medicare beneficiaries with no disabilities was $799. This cost increased six-fold, by $5148, among beneficiaries with mild disability, by $9045 for beneficiaries with moderate disability, by $5513 for those with severe disability, and by $8557 for persons with complete disability (P < 0.001). Persons reporting having foregone or delayed needed medical care because of financial difficulties (+$2082, P = .05), those experiencing low satisfaction with care coordination (+$1714, P = .01), and those reporting low satisfaction with access to care (+$1237, P = .02) also incurred significant excess ACS hospitalization costs relative to persons reporting no such barriers. This pattern held true for those with and without a disability, but were especially marked among persons with no functional limitations. These findings suggest that a better understanding of how public policy might effectively improve care coordination and reduce financial barriers to care is essential to formulating programs that reduce excess hospitalizations among the large and growing number of elderly Medicare beneficiaries.
Author List
Pezzin LE, Bogner HR, Kurichi JE, Kwong PL, Streim JE, Xie D, Na L, Hennessy SAuthor
Liliana Pezzin PhD, JD Professor in the Institute for Health and Equity department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAged, 80 and over
Ambulatory Care
Disabled Persons
Female
Health Services Accessibility
Hospital Costs
Hospitalization
Humans
Male
Medicare
Quality Indicators, Health Care
United States