Alzheimer disease and related dementia (ADRD) is associated with higher readmission rates and health care costs compared with patients without ADRD, according to study findings published in JAMA Network Open.
As the prevalence of ADRD increases, a greater proportion of patients admitted to the hospital are present with ADRD. Data suggests that patients with ADRD are readmitted to the hospital at a higher rate compared with the general population. This study was designed to evaluate the rate of readmission and associated costs in the ADRD setting.
Researchers sourced data for this study from the Michigan Value Collaborative (MVC) which includes data from 100 acute care hospitals in the state. Claims between 2012 and 2017 were evaluated for readmissions and costs within 30 days on the basis of ADRD diagnoses. To balance for differences between the patients with (n=66,676) and without (n=656,235) ADRD, a 1:1 propensity matching approach was used for a final sample size of 58,629 in each cohort.
Among the entire prematched cohort, the ADRD and control individuals were mean age, 83.4 (SD, 8.6) and 66.0 (SD, 15.4); 63.6% and 53.5% were women; 19.6% and 10.4% had congestive heart failure; 14.9% and 5.6% had stroke; and 11.5% and 2.0% had hip fractures, respectively.
In the propensity-matched analysis, risk for readmission at 30 days was 21.5% in ADRD compared with 14.7% among control individuals (mean difference [MD], 6.75%; 95% CI, 6.31%-7.19%) and the costs of readmissions were $8,378 and $7,912 (MD, $467; 95% CI, $289-$645), respectively.
Stratified by service line, the procedures or conditions with the highest risk for readmission in ADRD were coronary artery bypass graft, followed by noncancer colectomy, valve procedures, lung cancer resection, congestive heart failure, appendectomy, colorectal cancer, and atrial fibrillation. The lowest readmission rate was observed for patients who underwent joint replacement.
After accounting for readmission rates and costs, total episode payments ranged between $275 greater for acute myocardial events to $2,333 greater for hysterectomy among the ADRD group compared with control individuals.
These findings may have been biased, as ADRD is a difficult to diagnose condition and this study assumes that ADRD was correctly identified among the ADRD cohort and not underrecognized among controls.
Researchers found that patients with ADRD were at higher risk for readmissions within 30 days of hospital discharge and as such, higher health care costs. “Avoidable hospitalization undermines the quality of life and longevity, possibly increasing the risk for adverse events for patients with ADRD,” the researchers stated. They concluded, “Although more research is required to understand the variance across service lines in readmission risk between patients with and without ADRD, measures should be taken to ensure patient fitness for inpatient care.”
This article originally appeared on Neurology Advisor
Kamdar N, Syrjamaki J, Aikens JE, Mahmoudi E. Readmission rates and episode costs for Alzheimer disease and related dementias across hospitals in a statewide collaborative. JAMA Netw Open. Published online March 16, 2023. doi:10.1001/jamanetworkopen.2023.2109