Shivayne Gandotra
Research Mentor(s): Elham Mahmoudi
Mentor Department: Family Medicine
Authors: Elham Mahmoudi
Session: Session 2 (10:00am – 10:50am)
Presentation Type: Poster 37
Abstract
Research Objective: Potentially preventable hospitalizations (PPHs) are costly and harmful to older adults, particularly those with dementia. There is a paucity of evidence regarding adverse health events after a PPH among older adults with dementia. We aimed to examine mortality and long-term institutionalization (adverse health events) after a PPH among different subpopulations of dementia patients based on their race/ethnicity, rurality, and neighborhood characteristics. We hypothesized a higher rate of adverse health events among disadvantaged groups. Study Design: In this cross-sectional study, we used the 20% random sample of 2018-2019 traditional Medicare claims data and merged it with (1) the Area Health Resource File at the county level and (2) the National Neighborhood Data Archive at the Zip Code Tabulation level. We used 2018 data as a look-back period to select community-dwelling older adults (65+) with a dementia diagnosis who enrolled in 2018 and 2019 traditional Medicare with at least one hospitalization in 2018 (n= 61,478). We used multivariable, generalized, linear mixed models adjusting for age, sex, race/ethnicity, composite measure of frailty index, dual-eligibility, neighborhood characteristics (using a composite measure of a disadvantaged neighborhood index), and number of primary care physicians per 1000 people and hospitals per 100,000 people at a county level’s population. The main exposure variable was the number of PPH in2018. We categorized the number of PPH into three mutually exclusive groups of 0, 1, and 1+ PPH. We examined the odds of mortality or long-term institutionalizations among (1) everyone, (2) racial/ethnic minorities, (3) those in disadvantaged neighborhoods, and (4) those in rural areas. Population Studied: Patients with dementia diagnosis. Principal Findings: Among beneficiaries with at least one hospitalization in 2018, 27%, 33%, and40% of those with no PPH, one PPH, and more than one PPH in 2018, respectively, died in 2019. Similarly, 32%, 38%, and 47% of people with no PPH, one PPH, and more than one PPH in 2018, respectively, were institutionalized in 2019. Odds of mortality for Medicare beneficiaries with dementia increased by 24% with one PPH [aOR=1.24; 95% CI=1.19-1.29] and 58% by more than one PPH in 2018 [aOR=1.58; 95% CI=1.45-1.73]. Among those who survived, having one PPH was associated with increased odds of institutionalization by 7% [aOR=1.07; 95% CI=1.02-1.11] and by 25% with more than one PPH [aOR=1.25; 95% CI=1.14-1.37]. The adjusted predicted average shows a higher mortality rate [no PPH: 28% vs. 27%; 1 PPH: 34% vs. 33%; 1+ PPH: 48% vs. 39%] and institutionalization [no PPH:37% vs. 31%; 1 PPH: 44% vs 36%, 49% vs. 46%] after PPH in rural vs. non-rural areas, with no substantial differences among racial/ethnic groups or among people living in disadvantaged vs. more affluent neighborhoods. Conclusions: PPH substantially increases the odds of mortality and long-term institutionalization among Medicare beneficiaries with dementia. Mortality and institutionalization after PPH were higher among people in rural areas compared with non-rural are First Presenting Author
