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. 2019 Jan 25:11:125-135.
doi: 10.1016/j.dadm.2018.12.005. eCollection 2019 Dec.

Trends in health service use and potentially avoidable hospitalizations before Alzheimer's disease diagnosis: A matched, retrospective study of US Medicare beneficiaries

Urvi Desai  1 , Noam Y Kirson  1 , Wenyu Ye  2 , Nori R Mehta  1 , Jody Wen  1 , J Scott Andrews  2
Affiliations

Trends in health service use and potentially avoidable hospitalizations before Alzheimer's disease diagnosis: A matched, retrospective study of US Medicare beneficiaries

Urvi Desai et al. Alzheimers Dement (Amst). .

Abstract

Introduction: This study evaluates rates of all-cause emergency department visits, all-cause hospitalizations, potentially avoidable hospitalizations, and falls in 3 years preceding Alzheimer's disease (AD) diagnosis.

Methods: Patients with AD and controls with no cognitive impairment were identified from the Medicare claims data. Patients were required to be aged ≥ 65 years and have continuous Medicare enrollment for ≥4 years before the index date (AD cohort: first AD diagnosis in 2012-2014; controls: randomly selected medical claim). Outcomes for each preindex year were compared among propensity score-matched cohorts.

Results: Each year, before index, patients with AD were more likely to have all-cause emergency department visits, all-cause hospitalizations, potentially avoidable hospitalizations, and falls (P < .05 for all comparisons) than matched controls (N = 19,679 pairs). Increasing absolute and relative risks over time were observed for all outcomes.

Discussion: The study findings highlight the growing burden of illness before AD diagnosis and emphasize the need for timely recognition and management of patients with AD.

Keywords: Alzheimer's disease; Costs; Falls; Hospitalizations; PAH.

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Figures

Fig. 1
Fig. 1
Sample selection and resulting patient counts. Abbreviations: AD, Alzheimer's disease; ADRD, Alzheimer's disease and related dementia; CI, cognitive impairment; HMO, health maintenance organization. *Index for AD cohort: first AD diagnosis; for controls: date of a randomly selected medical claim.
Fig. 2
Fig. 2
Rates of and costs associated with all-cause ED visits during each year before index (N = 19,679 matched pairs). P < .01 for all comparisons, evaluated using McNemar's tests for proportions and Wilcoxon sign-rank test for continuous measures. Average per-patient costs (from Medicare perspective) were estimated among all patients within a cohort, including those with no ED visit during the relevant year. Abbreviations: AD, Alzheimer's disease; ED, emergency department.
Fig. 3
Fig. 3
Rates of and costs associated with all-cause hospitalizations during each year before index (N = 19,679 matched pairs). P < .01 for all comparisons, evaluated using McNemar's tests for proportions and Wilcoxon sign-rank test for continuous measures. Average per-patient costs (from Medicare perspective) were estimated among all patients within a cohort, including those with no hospitalization during the relevant year. Abbreviation: AD, Alzheimer's disease.
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References

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