30-Day Emergency Department Revisit Rates among Older Adults with Documented Dementia

Tyler Kent, Adriane Lesser, Juhi Israni, Ula Hwang, Christopher Carpenter, Kelly J Ko, Tyler Kent, Adriane Lesser, Juhi Israni, Ula Hwang, Christopher Carpenter, Kelly J Ko

Abstract

Objectives: Published literature on national emergency department (ED) revisit rates among older adults with dementia is sparse, despite anecdotal evidence of higher ED utilization. Thus we evaluated the odds ratio (OR) of 30-day ED revisits among older adults with dementia using a nationally representative sample.

Design: We assessed the frequency of claims associated with a 30-day ED revisit among Medicare beneficiaries with and without a dementia diagnosis before or at index ED visit. We used a logistic regression model controlling for dementia, age, sex, race, region, Medicaid status, transfer to a skilled nursing facility after ED, primary care physician use 12 months before index, and comorbidity.

Setting: A nationally representative sample of claims data for Medicare beneficiaries aged 65 and older who maintained continuous fee-for-service enrollment during 2015 and 2016. Only outpatient claims associated with an ED visit between January 2016 and November 2016 were included as a qualifying index encounter.

Participants: We identified 240 249 patients without dementia and 54 622 patients for whom a dementia code was recorded in the year before the index encounter in 2016.

Results: Our results indicate a significant difference in unadjusted 30-day ED revisit rates among those with an ED dementia diagnoses (22.0%) compared with those without (13.9%). Our adjusted results indicated that dementia is a significant predictor of 30-day ED revisits (P < .0001). Those with a dementia diagnosis at or before the index ED visit were more likely to have experienced an ED revisit within 30 days (OR = 1.27; 95% confidence interval = 1.24-1.31).

Conclusion: Dementia diagnoses were a significant predictor of 30-day ED revisits. Further research should assess potential reasons why dementia is associated with markedly higher revisit rates, as well as opportunities to manage and transition dementia patients from the ED back to the community more effectively. J Am Geriatr Soc 67:2254-2259, 2019.

Keywords: dementia; emergency; geriatric; revisits.

© 2019 The Authors. Journal of the American Geriatrics Society published by Wiley Periodicals, Inc. on behalf of The American Geriatrics Society.

Figures

Figure 1
Figure 1
Inclusion criteria. ED, emergency department; FFS, fee for service.

References

    1. Alzheimer'sAssociation . Alzheimer's disease facts and figures. Alzheimers Dement. 2017;13(4):325‐373.
    1. LaMantia MA, Stump TE, Messina FC, et al. Emergency department use among older adults with dementia. Alzheimer Dis Assoc Disord. 2016;30(1):35‐40.
    1. Hunt LJ, Coombs LA, Stephens CE. Emergency department use by community‐dwelling individuals with dementia in the United States: an integrative review. J Gerontol Nurs. 2018;44(3):23‐30.
    1. Wolinsky FD, Liu L, Miller TR, et al. Emergency department utilization patterns among older adults. J Gerontol. 2008;63(2):204‐209.
    1. Bynum JP, Rabins PV, Weller W, et al. The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital use. J Am Geriatr Soc. 2004;52(2):187‐194.
    1. Benner M, Steiner V, Pierce LL. Family caregivers' reports of hospitalizations and emergency department visits in community‐dwelling individuals with dementia. Dementia. 2018;17(5):585–595. 10.1177/1471301216653537.
    1. LaMantia MA, Lane KA, Tu W, et al. Patterns of emergency department use among long‐stay nursing home residents with differing levels of dementia severity. J Am Med Dir Assoc. 2016;17(6):541‐546.
    1. Parke B, Hunter KF. The dementia‐friendly emergency department:an innovation to reducing incompatibilities at the local level. Healthc Manage Forum. 2017;30(1):26‐31.
    1. Bass DM, Judge KS, Maslow K, et al. Impact of the care coordination program “Partners in Dementia Care” on veterans' hospital admissions and emergency department visits. Alzheimer's Dementia. 2015;1(1):13‐22.
    1. Clevenger CK, Chu TA, Yang Z, Hepburn KW. Clinical care of persons with dementia in the emergency department: a review of the literature and agenda for research. J Am Geriatr Soc. 2012;60(9):1742‐1748.
    1. Maslow K, Mezey M. Adverse health events in hospitalized patients with dementia. Am J Nurs. 2008;108(1):1.
    1. Daras LC, Feng Z, Wiener JM, Kaganova Y. Medicare expenditures associated with hospital and emergency department use among beneficiaries with dementia. Inquiry. 2017;54:46958017696757. 10.1177/0046958017696757.
    1. Han C‐Y, Chen L‐C, Barnard A, et al. Early revisit to the emergency department: an integrative review. J Emerg Nurs. 2015;41(4):285‐295.
    1. Keyes DC, Singal B, Kropf CW, Fisk A. Impact of a new senior emergency department on emergency department recidivism, rate of hospital admission, and hospital length of stay. Ann Emerg Med. 2014;63(5):517‐524.
    1. Jane M, Sylvie C, François B, et al. Return to the emergency department among elders: patterns and predictors. Acad Emerg Med. 2000;7(3):249‐259.
    1. Uscatescu VTA, Ezer H. Return visits to the emergency department: what can we learn from older adults' experiences? J Gerontol Nurs. 2014;40(7):32‐40.
    1. Meldon SW, Mion LC, Palmer RM, et al. A brief risk‐stratification tool to predict repeat emergency department visits and hospitalizationsin older patients discharged from the emergency department. Acad Emerg Med. 2003;10(3):224‐232.
    1. Aminzadeh F, Dalziel WB. Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions. Ann Emerg Med. 2002;39(3):238‐247.
    1. Andersen R. A Behavioral Model of Families' Use of Health Services. Chicago, IL: Center for Health Administration Studies; 1968.
    1. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1‐10.
    1. Andersen RM, Davidson PL, Baumeister SE. Chapter 2: Improving access to care In: Kominski GF, ed. Changing the U.S. Health Care System: Key Issues in Health Services Policy and Management. 4th ed. San Francisco, CA: John Wiley & Sons; 2014:33‐70.
    1. Zhu CW, Livote EE, Ross JS, Penrod JD. A random effects multinomial Logit analysis of using Medicare and VA healthcare among veterans with dementia. Home Health Care Serv Q. 2010;29(2):91‐104.
    1. Arbaje AI, Wolff JL, Yu Q, Powe NR, Anderson GF, Boult C. Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community‐dwelling Medicare beneficiaries. Gerontologist. 2008;48(4):495‐504.
    1. Shugarman LR, Sorbero MES, Tian H, Jain AK, Ashwood JS. An exploration of urban and rural differences in lung cancer survival among Medicare beneficiaries. Am J Public Health. 2008;98(7):1280‐1287.
    1. Newcomer RJ, Clay TH, Yaffe K, Covinsky KE. Mortality risk and prospective Medicare expenditures for persons with dementia. J Am Geriatr Soc. 2005;53(11):2001‐2006.
    1. How to identify hospital claims for emergency room visits in the Medicare claims data. 2015; . Accessed July 26, 2018.
    1. CMS Chronic Conditions Data Warehouse (CCW): CCW Condition Algorithms . Alzheimer's Disease, Related Disorders or Senile Dementia. Woodlawn, MD: Centers for Medicare & Medicaid Services; 2017.
    1. Deyo R, Cherkin D, Ciol M. Adapting a clinical comorbidity index for use with ICD‐9‐CM administrative databases. J Clin Epidemiol. 1992;45(6):613‐619.
    1. Callahan CM, Boustani MA, Unverzagt FW, et al. Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA. 2006;295(18):2148‐2157.
    1. Vickrey BG, Mittman BS, Connor KI, et al. The effect of a disease management intervention on quality and outcomes of dementia care: a randomized, controlled trial. Ann Intern Med. 2006;145(10):713‐726.
    1. US Department of Health & Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE). National Plan to Address Alzheimer's Disease : 2017. Update. . Accessed May 25, 2019.
    1. Bass DM, Judge KS, Snow AL, et al. A controlled trial of Partners in Dementia Care: veteran outcomes after six and twelve months. Alzheimers Res Ther. 2014;6(1):9‐9.
    1. Bass DM, Judge KS, Lynn Snow A, et al. Caregiver outcomes of partners in dementia care: effect of a care coordination program for veterans with dementia and their family members and friends. J Am Geriatr Soc. 2013;61(8):1377‐1386.
    1. Silverstein NM. In search of dementia‐friendly hospitals: a survey of patient care directors in Massachusetts In: Silverstein NM, Maslow K, eds. Improving Hospital Care for Persons with Dementia. New York, NY: Springer; 2005:23‐33.
    1. Carpenter CR, DesPain B, Keeling TN, Shah M, Rothenberger M. The six‐item screener and AD8 for the detection of cognitive impairment in geriatric emergency department patients. Ann Emerg Med. 2011;57(6):653‐661.
    1. Callahan CM, Hendrie HC, Tierney WM. Documentation and evaluation of cognitive impairment in elderly primary care patients. Ann Intern Med. 1995;122(6):422‐429.
    1. Morris JC. The clinical dementia rating (CDR). Neurology. 1993;43(11):2412‐2412‐a.

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