The Relationship Between a Dementia Diagnosis, Chronic Illness, Medicare Expenditures, and Hospital Use
Objectives: To determine whether dementia increases medical expenditures, the probability of hospitalization, and potentially preventable hospitalization, controlling for variables including age and comorbidity. Design: Cross‐sectional analysis of 1 year of claims data comparing usage by patients wi...
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| Veröffentlicht in: | Journal of the American Geriatrics Society (JAGS) 2004-02, Vol.52 (2), p.187-194 |
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| container_title | Journal of the American Geriatrics Society (JAGS) |
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| creator | Bynum, Julie P. W. Rabins, Peter V. Weller, Wendy Niefeld, Marlene Anderson, Gerard F. Wu, Albert W. |
| description | Objectives: To determine whether dementia increases medical expenditures, the probability of hospitalization, and potentially preventable hospitalization, controlling for variables including age and comorbidity.
Design: Cross‐sectional analysis of 1 year of claims data comparing usage by patients with claims for dementia with usage by those without dementia.
Setting: A nationally representative 5% random sample of Medicare beneficiaries in 1999.
Participants: Medicare beneficiaries aged 65 and older with fee‐for‐service Medicare Parts A and B coverage for 1999 (N=1,238,895; dementia patients n=103,512).
Measurements: Per capita expenditures, rate of all‐cause hospitalization, rate of preventable hospitalization as defined using ambulatory‐care sensitive condition (ACSC) admissions, and dementia identified using International Classification of Diseases, 9th Edition, codes 290, 294, and 331.
Results: Prevalence of dementia was 8.3%. In a model of expenditures in those who survived the year adjusting for age, sex, race, and comorbidity, dementia was associated with an incremental cost of $6,927, or 3.3 times greater total expenditures than in nondementia patients (P |
| doi_str_mv | 10.1111/j.1532-5415.2004.52054.x |
| format | Article |
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Design: Cross‐sectional analysis of 1 year of claims data comparing usage by patients with claims for dementia with usage by those without dementia.
Setting: A nationally representative 5% random sample of Medicare beneficiaries in 1999.
Participants: Medicare beneficiaries aged 65 and older with fee‐for‐service Medicare Parts A and B coverage for 1999 (N=1,238,895; dementia patients n=103,512).
Measurements: Per capita expenditures, rate of all‐cause hospitalization, rate of preventable hospitalization as defined using ambulatory‐care sensitive condition (ACSC) admissions, and dementia identified using International Classification of Diseases, 9th Edition, codes 290, 294, and 331.
Results: Prevalence of dementia was 8.3%. In a model of expenditures in those who survived the year adjusting for age, sex, race, and comorbidity, dementia was associated with an incremental cost of $6,927, or 3.3 times greater total expenditures than in nondementia patients (P<.001), with higher expenditures for each specific type of Medicare service. Hospitalization accounted for 54% of adjusted costs. The adjusted odds of hospitalization associated with dementia were 3.68 (95% confidence interval (CI)=3.62–3.73) and adjusted odds of ACSC hospitalization were 2.40 (95% CI=2.35–2.46). In those who died, the associations were positive but of smaller magnitude.
Conclusion: In a nationally representative sample, higher Medicare expenditures associated with a diagnosis of dementia are in large part due to increased hospitalization. Further study is needed into the factors associated with high rates of hospitalization in dementia patients including aspects of ambulatory management that may be improved. J Am Geriatr Soc 52:187–194, 2004.</description><identifier>ISSN: 0002-8614</identifier><identifier>EISSN: 1532-5415</identifier><identifier>DOI: 10.1111/j.1532-5415.2004.52054.x</identifier><identifier>PMID: 14728626</identifier><identifier>CODEN: JAGSAF</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Science Inc</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Case-Control Studies ; Chronic Disease - epidemiology ; Chronic diseases ; Chronic illnesses ; comorbid illness ; Comorbidity ; Cross-Sectional Studies ; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases ; Dementia ; Dementia - economics ; Dementia - epidemiology ; Elderly people ; Expenditure ; Fee-for-Service Plans - economics ; Female ; Health care ; Health care expenditures ; Health Expenditures - statistics & numerical data ; Hospital Costs - statistics & numerical data ; Hospitalization ; Hospitalization - economics ; Hospitalization - statistics & numerical data ; Humans ; Male ; Medical diagnosis ; Medical sciences ; Medicare ; Medicare - economics ; Neurology ; Odds Ratio ; Prevalence ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Specific populations (family, woman, child, elderly...) ; United States - epidemiology ; USA ; utilization</subject><ispartof>Journal of the American Geriatrics Society (JAGS), 2004-02, Vol.52 (2), p.187-194</ispartof><rights>2004 INIST-CNRS</rights><rights>Copyright Lippincott Williams & Wilkins Feb 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5584-e2a86737b60cad169b8fb2fa6d0d1522d1d9dd920ac79aae1ebe1b17ebde4abc3</citedby><cites>FETCH-LOGICAL-c5584-e2a86737b60cad169b8fb2fa6d0d1522d1d9dd920ac79aae1ebe1b17ebde4abc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1532-5415.2004.52054.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1532-5415.2004.52054.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27933,27934,31009,45583,45584</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15583508$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14728626$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bynum, Julie P. W.</creatorcontrib><creatorcontrib>Rabins, Peter V.</creatorcontrib><creatorcontrib>Weller, Wendy</creatorcontrib><creatorcontrib>Niefeld, Marlene</creatorcontrib><creatorcontrib>Anderson, Gerard F.</creatorcontrib><creatorcontrib>Wu, Albert W.</creatorcontrib><title>The Relationship Between a Dementia Diagnosis, Chronic Illness, Medicare Expenditures, and Hospital Use</title><title>Journal of the American Geriatrics Society (JAGS)</title><addtitle>J Am Geriatr Soc</addtitle><description>Objectives: To determine whether dementia increases medical expenditures, the probability of hospitalization, and potentially preventable hospitalization, controlling for variables including age and comorbidity.
Design: Cross‐sectional analysis of 1 year of claims data comparing usage by patients with claims for dementia with usage by those without dementia.
Setting: A nationally representative 5% random sample of Medicare beneficiaries in 1999.
Participants: Medicare beneficiaries aged 65 and older with fee‐for‐service Medicare Parts A and B coverage for 1999 (N=1,238,895; dementia patients n=103,512).
Measurements: Per capita expenditures, rate of all‐cause hospitalization, rate of preventable hospitalization as defined using ambulatory‐care sensitive condition (ACSC) admissions, and dementia identified using International Classification of Diseases, 9th Edition, codes 290, 294, and 331.
Results: Prevalence of dementia was 8.3%. In a model of expenditures in those who survived the year adjusting for age, sex, race, and comorbidity, dementia was associated with an incremental cost of $6,927, or 3.3 times greater total expenditures than in nondementia patients (P<.001), with higher expenditures for each specific type of Medicare service. Hospitalization accounted for 54% of adjusted costs. The adjusted odds of hospitalization associated with dementia were 3.68 (95% confidence interval (CI)=3.62–3.73) and adjusted odds of ACSC hospitalization were 2.40 (95% CI=2.35–2.46). In those who died, the associations were positive but of smaller magnitude.
Conclusion: In a nationally representative sample, higher Medicare expenditures associated with a diagnosis of dementia are in large part due to increased hospitalization. Further study is needed into the factors associated with high rates of hospitalization in dementia patients including aspects of ambulatory management that may be improved. J Am Geriatr Soc 52:187–194, 2004.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Case-Control Studies</subject><subject>Chronic Disease - epidemiology</subject><subject>Chronic diseases</subject><subject>Chronic illnesses</subject><subject>comorbid illness</subject><subject>Comorbidity</subject><subject>Cross-Sectional Studies</subject><subject>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</subject><subject>Dementia</subject><subject>Dementia - economics</subject><subject>Dementia - epidemiology</subject><subject>Elderly people</subject><subject>Expenditure</subject><subject>Fee-for-Service Plans - economics</subject><subject>Female</subject><subject>Health care</subject><subject>Health care expenditures</subject><subject>Health Expenditures - statistics & numerical data</subject><subject>Hospital Costs - statistics & numerical data</subject><subject>Hospitalization</subject><subject>Hospitalization - economics</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medical sciences</subject><subject>Medicare</subject><subject>Medicare - economics</subject><subject>Neurology</subject><subject>Odds Ratio</subject><subject>Prevalence</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Specific populations (family, woman, child, elderly...)</subject><subject>United States - epidemiology</subject><subject>USA</subject><subject>utilization</subject><issn>0002-8614</issn><issn>1532-5415</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>7QJ</sourceid><recordid>eNqNkcFu1DAQhi0EokvhFZCFBCcSbCdOnAsSLGXbqoAorZC4WJN4tutt1gl2om7fHqe7aiUu4Iut8Te_7PkIoZylPK5365TLTCQy5zIVjOWpFEzm6fYRmd1fPCYzxphIVMHzA_IshDVjXDClnpIDnpdCFaKYkauLFdJzbGGwnQsr29OPONwgOgr0E27QDTYeLFy5Ltjwls5XvnO2oSdt6zDEwhc0tgGP9GjbozN2GD3GMjhDj7vQ2wFaehnwOXmyhDbgi_1-SC4_H13Mj5Ozb4uT-YezpJFS5QkKUEWZlXXBGjC8qGq1rMUSCsMMl0IYbipjKsGgKSsA5Fgjr3mJtcEc6iY7JG92ub3vfo8YBr2xocG2BYfdGLRinOWZkv8EZRmHlGdlBF_9Ba670bv4CS04yxRn1ZSmdlDjuxA8LnXv7Qb8reZMT8r0Wk9m9GRGT8r0nTK9ja0v9_ljvUHz0Lh3FIHXewBCA-3Sg2tseODi4DLJVOTe77gb2-Ltfz9Any5-3B1jQLILsGHA7X0A-Gs9OZH659eF_r44r-a_5KmW2R9L4cD8</recordid><startdate>200402</startdate><enddate>200402</enddate><creator>Bynum, Julie P. W.</creator><creator>Rabins, Peter V.</creator><creator>Weller, Wendy</creator><creator>Niefeld, Marlene</creator><creator>Anderson, Gerard F.</creator><creator>Wu, Albert W.</creator><general>Blackwell Science Inc</general><general>Blackwell</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7TK</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7QJ</scope><scope>7X8</scope></search><sort><creationdate>200402</creationdate><title>The Relationship Between a Dementia Diagnosis, Chronic Illness, Medicare Expenditures, and Hospital Use</title><author>Bynum, Julie P. W. ; Rabins, Peter V. ; Weller, Wendy ; Niefeld, Marlene ; Anderson, Gerard F. ; Wu, Albert W.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5584-e2a86737b60cad169b8fb2fa6d0d1522d1d9dd920ac79aae1ebe1b17ebde4abc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Case-Control Studies</topic><topic>Chronic Disease - epidemiology</topic><topic>Chronic diseases</topic><topic>Chronic illnesses</topic><topic>comorbid illness</topic><topic>Comorbidity</topic><topic>Cross-Sectional Studies</topic><topic>Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases</topic><topic>Dementia</topic><topic>Dementia - economics</topic><topic>Dementia - epidemiology</topic><topic>Elderly people</topic><topic>Expenditure</topic><topic>Fee-for-Service Plans - economics</topic><topic>Female</topic><topic>Health care</topic><topic>Health care expenditures</topic><topic>Health Expenditures - statistics & numerical data</topic><topic>Hospital Costs - statistics & numerical data</topic><topic>Hospitalization</topic><topic>Hospitalization - economics</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Male</topic><topic>Medical diagnosis</topic><topic>Medical sciences</topic><topic>Medicare</topic><topic>Medicare - economics</topic><topic>Neurology</topic><topic>Odds Ratio</topic><topic>Prevalence</topic><topic>Prevention and actions</topic><topic>Public health. Hygiene</topic><topic>Public health. 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W.</creatorcontrib><creatorcontrib>Rabins, Peter V.</creatorcontrib><creatorcontrib>Weller, Wendy</creatorcontrib><creatorcontrib>Niefeld, Marlene</creatorcontrib><creatorcontrib>Anderson, Gerard F.</creatorcontrib><creatorcontrib>Wu, Albert W.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bynum, Julie P. W.</au><au>Rabins, Peter V.</au><au>Weller, Wendy</au><au>Niefeld, Marlene</au><au>Anderson, Gerard F.</au><au>Wu, Albert W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Relationship Between a Dementia Diagnosis, Chronic Illness, Medicare Expenditures, and Hospital Use</atitle><jtitle>Journal of the American Geriatrics Society (JAGS)</jtitle><addtitle>J Am Geriatr Soc</addtitle><date>2004-02</date><risdate>2004</risdate><volume>52</volume><issue>2</issue><spage>187</spage><epage>194</epage><pages>187-194</pages><issn>0002-8614</issn><eissn>1532-5415</eissn><coden>JAGSAF</coden><abstract>Objectives: To determine whether dementia increases medical expenditures, the probability of hospitalization, and potentially preventable hospitalization, controlling for variables including age and comorbidity.
Design: Cross‐sectional analysis of 1 year of claims data comparing usage by patients with claims for dementia with usage by those without dementia.
Setting: A nationally representative 5% random sample of Medicare beneficiaries in 1999.
Participants: Medicare beneficiaries aged 65 and older with fee‐for‐service Medicare Parts A and B coverage for 1999 (N=1,238,895; dementia patients n=103,512).
Measurements: Per capita expenditures, rate of all‐cause hospitalization, rate of preventable hospitalization as defined using ambulatory‐care sensitive condition (ACSC) admissions, and dementia identified using International Classification of Diseases, 9th Edition, codes 290, 294, and 331.
Results: Prevalence of dementia was 8.3%. In a model of expenditures in those who survived the year adjusting for age, sex, race, and comorbidity, dementia was associated with an incremental cost of $6,927, or 3.3 times greater total expenditures than in nondementia patients (P<.001), with higher expenditures for each specific type of Medicare service. Hospitalization accounted for 54% of adjusted costs. The adjusted odds of hospitalization associated with dementia were 3.68 (95% confidence interval (CI)=3.62–3.73) and adjusted odds of ACSC hospitalization were 2.40 (95% CI=2.35–2.46). In those who died, the associations were positive but of smaller magnitude.
Conclusion: In a nationally representative sample, higher Medicare expenditures associated with a diagnosis of dementia are in large part due to increased hospitalization. Further study is needed into the factors associated with high rates of hospitalization in dementia patients including aspects of ambulatory management that may be improved. J Am Geriatr Soc 52:187–194, 2004.</abstract><cop>Oxford, UK</cop><pub>Blackwell Science Inc</pub><pmid>14728626</pmid><doi>10.1111/j.1532-5415.2004.52054.x</doi><tpages>8</tpages></addata></record> |
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| ispartof | Journal of the American Geriatrics Society (JAGS), 2004-02, Vol.52 (2), p.187-194 |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE; Applied Social Sciences Index & Abstracts (ASSIA) |
| subjects | Aged Aged, 80 and over Biological and medical sciences Case-Control Studies Chronic Disease - epidemiology Chronic diseases Chronic illnesses comorbid illness Comorbidity Cross-Sectional Studies Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases Dementia Dementia - economics Dementia - epidemiology Elderly people Expenditure Fee-for-Service Plans - economics Female Health care Health care expenditures Health Expenditures - statistics & numerical data Hospital Costs - statistics & numerical data Hospitalization Hospitalization - economics Hospitalization - statistics & numerical data Humans Male Medical diagnosis Medical sciences Medicare Medicare - economics Neurology Odds Ratio Prevalence Prevention and actions Public health. Hygiene Public health. Hygiene-occupational medicine Specific populations (family, woman, child, elderly...) United States - epidemiology USA utilization |
| title | The Relationship Between a Dementia Diagnosis, Chronic Illness, Medicare Expenditures, and Hospital Use |
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