title: Potentially Avoidable Hospitalizations among People at Different Activity of Daily Living Limitation Stages.
abstract: To determine whether higher activity of daily living (ADL) limitation stages are associated with increased risk of hospitalization, particularly for ambulatory care sensitive (ACS) conditions.
  
  
  
  Secondary data analysis, including 8,815 beneficiaries from 2005 to 2006 Medicare Current Beneficiary Survey (MCBS).
  
  
  
  ADL limitation stages (0-IV) were determined at the end of 2005. Hospitalization rates were calculated for 2006 and age adjusted using direct standardization. Multivariate negative binomial regression, adjusting for baseline demographic and health characteristics, with the outcome hospitalization count was performed to estimate the adjusted rate ratio of ACS and non-ACS hospitalizations for beneficiaries with ADL stages > 0 compared to beneficiaries without limitations.
  
  
  
  Baseline ADL stage and health conditions were assessed using 2005 MCBS data and count of hospitalization determined using 2006 MCBS data.
  
  
  
  Referenced to stage 0, the adjusted rate ratios (95 percent confidence interval) for stage I to stage IV ranged from 1.9 (1.4-2.5) to 4.1 (2.2-7.8) for ACS hospitalizations compared with from 1.6 (1.3-1.9) to 1.8 (1.4-2.5) for non-ACS hospitalizations.
  
  
  
  Hospitalization rates for ACS conditions increased more dramatically with ADL limitation stage than did rates for non-ACS conditions. Adults with ADL limitations appear particularly vulnerable to potentially preventable hospitalizations for conditions typically manageable in ambulatory settings.
authors.affiliation: Department of Veterans Affairs Palo Alto Health Care System, Spinal Cord Injury and Disorders Center, Palo Alto, CA.|Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Sophia Miryam
authors.identifier: 0000-0002-6311-6671
authors.initials: SM
authors.lastname: Schüssler-Fiorenza Rose
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA.|Perelman School of Medicine University of Pennsylvania, Philadelphia, PA.
authors.forename: Margaret G
authors.initials: MG
authors.lastname: Stineman
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Pan
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Hillary
authors.initials: H
authors.lastname: Bogner
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jibby E
authors.initials: JE
authors.lastname: Kurichi
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.|Mental Illness Research Education and Clinical Center Philadelphia Veterans Affairs Medical Center, Philadelphia, PA.
authors.forename: Joel E
authors.initials: JE
authors.lastname: Streim
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA.
authors.forename: Dawei
authors.initials: D
authors.lastname: Xie
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
keywords: Ambulatory care; disabled persons; health services accessibility; hospitalization; primary health care