title: Depression and ambulatory care sensitive hospitalizations among Medicare beneficiaries with chronic physical conditions.
abstract: OBJECTIVE
  We examined the association between depression and hospitalizations for Ambulatory Care Sensitive Conditions (H-ACSC) among Medicare beneficiaries with chronic physical conditions.
  
  
  METHODS
  We used a retrospective longitudinal design using multiple years (2002-2009) of linked fee-for-service Medicare claims and survey data from Medicare Current Beneficiary Survey to create six longitudinal panels. We followed individuals in each panel for a period of 3-years; first year served as the baseline and subsequent 2-years served as the follow-up. We measured depression, chronic physical conditions and other characteristics at baseline and examined H-ACSC at follow-up. We identified chronic physical conditions from survey data and H-ACSC and depression from fee-for-service Medicare claims. We analyzed unadjusted and adjusted relationships between depression and the risk of H-ACSC with chi-square tests and logistic regressions.
  
  
  RESULTS
  Among all Medicare beneficiaries, 9.3% had diagnosed depression. Medicare beneficiaries with depression had higher rates of any H-ACSC as compared to those without depression (13.6% vs. 7.7%). Multivariable regression indicated that, compared to those without depression, Medicare beneficiaries with depression were more likely to experience any H-ACSC.
  
  
  CONCLUSIONS
  Depression was associated with greater risk of H-ACSC, suggesting that health care quality measures may need to include depression as a risk-adjustment variable.
authors.affiliation: Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA. Electronic address: rbhattacharya@hsc.wvu.edu.
authors.forename: Rituparna
authors.initials: R
authors.lastname: Bhattacharya
authors.affiliation: Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Chan
authors.initials: C
authors.lastname: Shen
authors.affiliation: Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA.
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States
keywords: Ambulatory care sensitive conditions; Depression; Medicare; Preventable hospitalizations