Emergency department and inpatient utilization among U.S. older adults with multiple chronic conditions: a post-reform update

BMC Health Services Research

Matthew Lee Smith¹  Mustafa Hussein²  Asos Mahmood³  SangNam Ahn³ 

[1] Center for Population Health and Aging, Texas A&M University;Joseph J. Zilber School of Public Health, University of Wisconsin;The Division of Health Systems Management and Policy, School of Public Health, The University of Memphis;

关键词: Affordable care act;    Multiple chronic conditions;    Emergency department (ED) visits;    Inpatient visits;    Length of stay (LOS);    Older adults;   

DOI  :  10.1186/s12913-020-4902-7

来源: DOAJ

【 摘 要 】

Abstract Background The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update. Methods We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006–2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006–2010), during (2011–2013), and after the ACA (2014–2015). Results Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: − 2.9, 0.2, p < 0.1], after multivariable adjustment. Conclusions We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.

【 授权许可】

Unknown