title: Association of dementia with early rehospitalization among Medicare beneficiaries.
abstract: Preventable hospital readmissions have been recognized as indicators of hospital quality, a source of increased healthcare expenditures, and a burden for patients, families, and caregivers. Despite growth of initiatives targeting risk factors associated with potentially avoidable hospital readmissions, the impact of dementia on the likelihood of rehospitalization is poorly characterized. Therefore, the primary objective of this retrospective cohort study was to investigate whether dementia was an independent predictor of 30-day readmissions. Administrative claims data for all admissions to Rhode Island hospitals in 2009 was utilized to identify hospitalizations of Medicare fee-for-service beneficiaries with a diagnosis of Alzheimer's Disease or other dementias. Demographics, measures of comorbid disease burden, and other potential confounders were extracted from the data and the odds of 30-day readmission to any United States hospital was calculated from conditional logistic regression models. From a sample of 25,839 hospitalizations, there were 3908 index admissions of Medicare beneficiaries who fulfilled the study criteria for a dementia diagnosis. Nearly 20% of admissions (n=5133) were followed by a readmission within thirty days. Hospitalizations of beneficiaries with a dementia diagnosis were more likely to be followed by a readmission within thirty days (adjusted odds ratio (AOR) 1.18; 95% CI, 1.08, 1.29), compared to hospitalizations of those of without dementia. Controlling for discharge site of care did not attenuate the association (AOR 1.21; 95% CI, 1.10, 1.33).
authors.affiliation: Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence, RI, USA. Electronic address: lori_daiello@brown.edu.
authors.forename: Lori A
authors.initials: LA
authors.lastname: Daiello
authors.affiliation: Healthcentric Advisors, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Rebekah
authors.initials: R
authors.lastname: Gardner
authors.affiliation: Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Geriatric Psychiatry, Providence, RI, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Epstein-Lubow
authors.affiliation: Healthcentric Advisors, Providence, RI, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Butterfield
authors.affiliation: Healthcentric Advisors, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: Stefan
authors.initials: S
authors.lastname: Gravenstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003704:Dementia / Q000191:economics / Q000628:therapy*; D018588:Fee-for-Service Plans; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012237:Rhode Island; D012307:Risk Factors; D014481:United States
keywords: Aged; Dementia; Hospitalization; Patient readmission