TORONTO – In 2013, Medicare spent $2.6 billion on potentially avoidable hospitalizations for patients with Alzheimer’s disease and other dementias.
About half of these hospital visits – each of which cost Medicare around $7,000 – were for conditions that could have been effectively managed in primary care settings, Pei-Jung Lin, PhD, said at the Alzheimer’s Association International Conference 2016.
Dr. Pei-Jung Lin
Half of the admissions were for chronic illnesses such as diabetes, hypertension, and asthma that are often poorly controlled as dementia progresses. The other half was for acute illnesses, said Dr. Lin, director of the Center for the Evaluation of Value and Risk in Health at Tufts University, Boston. But these admissions for acute conditions involved problems that could be treated on an outpatient basis if they’d been caught early – urinary tract infections, pneumonias, and dehydration.
“In 2013, 1 in 10 Alzheimer’s disease patients had at least one potentially avoidable hospitalization, and 1 in 7 hospital admissions among these patients (14%) was for a potentially avoidable condition,” she said during a press briefing.
Although the financial finding is striking, it isn’t the whole story, Dr. Lin said. Hospitalizations put patients at increased risk for infections, confusion, and delirium – any of which can initiate a downward clinical spiral that results in more intervention, more stress, and more cost.
“Not only are these incidences expensive, they can be dangerous for our patients. Being in the hospital is stressful for someone with little grasp of reality. Patients can become even more confused and disoriented. They’re at risk for hospital-acquired infections, which increase costs and caregiver stress, and decrease patient quality of life,” she said.
Dr. Lin and her team looked for potentially avoidable hospitalizations filed in 2013 among 2.75 million patients with Alzheimer’s and other dementias. The acute conditions included in the analysis were bacterial pneumonia, urinary tract infection, and dehydration, and chronic conditions were diabetes, cardiovascular diseases, and respiratory conditions.
About half these admissions (188,870; 47%) were for acute conditions, while the rest were for chronic conditions. About half of all the admissions also occurred in patients with late-stage disease, and these were the most expensive ones. Admissions for these late-stage patients accounted for 59% of the expenditures and cost Medicare $1.53 billion in 2013.
Claims data don’t offer the kind of details that allow a case-by-case review of how the admissions could have been prevented. But one message comes through loud and clear, Dr. Lin said.
“Comorbidity management is simply not optimal among many of our patients with Alzheimer’s disease. Many of these admissions, and much of this cost, could have been prevented with better ambulatory care and early, effective treatment.”
Dr. Richard Caselli, professor of neurology at the Mayo Clinic, Scottsdale, Ariz., commented on these issues in a video interview.
Dr. Lin had no financial disclosures.
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