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• W4297523778 abstract "ObjectivesAmong older adults living with dementia, nearly 1 in 2 will experience an ED visit annually. Most ED visits among those with dementia result in discharge from the ED; however, they are associated with more frequent ED revisits and hospitalizations. Little is known regarding how often older adults with Alzheimer’s disease and related dementias (ADRD) have a follow-up visit after ED discharge and what outcomes are associated with those who have follow-up.MethodsWe conducted an observational study of ED visits resulting in discharge among Medicare beneficiaries aged 65 and older from 2011-2016. We included continuously enrolled beneficiaries with a history of Alzheimer’s disease and related dementias (ADRD) as defined by the Chronic Conditions Warehouse. We excluded patients who died, were transferred, observed, hospitalized, or discharged to a nursing facility or rehabilitation center. We identified characteristics associated with any non-ED ambulatory follow-up visit within 30 days, including beneficiary characteristics (age, sex, race, Medicaid eligibility), principal visit diagnosis category (using 38 categories designed for emergency care health services research), and hospital factors (size, region, urban/rural location, teaching status, ownership, safety-net status). We fit a Kaplan-Meier curve to estimate the time-dependent probability of ambulatory follow-up after ED discharge, treating death as a competing risk and 30 days as the censoring time. We fit a Cox regression model with time to follow-up as outcome, death as a competing risk, 30 days as the censoring time, and adjusted for all covariates and hospital-level clustering by stratifying by hospital. We performed 3 separate Cox regression models for mortality, ED revisits, and hospitalizations within 30 days of ED discharge, using the same specifications as the follow-up model and also including follow-up visit as a time-varying covariate.ResultsBetween 2011-2016, there were 2,075,085 ED discharges among beneficiaries with ADRD. Mean age was 82.3 years, 65.3% were women, 11.8% were Black, and 2.5% were Hispanic. The rate of ambulatory follow-up was 33.8% within 7 days and 62.8% within 30 days. With respect to outcomes, 2.8% died, 22.8% experienced an ED revisit, and 15% were hospitalized within 30 days. Characteristics associated with lower hazard of post-discharge ambulatory follow-up included Medicaid eligibility (HR 0.73, 95% CI 0.72-0.73; P<.001); Black race (HR 0.87, 95% CI 0.85-0.88; P<.001); treatment at a rural ED (HR 0.75, 95% CI 0.73-0.78; P<.001). After adjusting for patient and hospital characteristics, beneficiaries who completed ambulatory follow-up had a lower hazard of mortality (HR 0.43, 95% CI 0.42-0.44; P<.001), higher hazard of ED revisit (HR 1.06, 95% CI 1.06-1.07; P<.001) and higher hazard of hospitalization (HR 1.16, 95% CI 1.15-1.16; P<.001) within 30 days.ConclusionFollow-up care after ED discharge is associated with reduced mortality; however, one in three older adults with dementia lacks follow-up care within 30 days. Beneficiaries with dementia who are Black, eligible for Medicaid, and are treated at rural hospitals experience disproportionate barriers to accessing care, which exacerbates disparities in health outcomes for this vulnerable group.No, authors do not have interests to disclose ObjectivesAmong older adults living with dementia, nearly 1 in 2 will experience an ED visit annually. Most ED visits among those with dementia result in discharge from the ED; however, they are associated with more frequent ED revisits and hospitalizations. Little is known regarding how often older adults with Alzheimer’s disease and related dementias (ADRD) have a follow-up visit after ED discharge and what outcomes are associated with those who have follow-up. Among older adults living with dementia, nearly 1 in 2 will experience an ED visit annually. Most ED visits among those with dementia result in discharge from the ED; however, they are associated with more frequent ED revisits and hospitalizations. Little is known regarding how often older adults with Alzheimer’s disease and related dementias (ADRD) have a follow-up visit after ED discharge and what outcomes are associated with those who have follow-up. MethodsWe conducted an observational study of ED visits resulting in discharge among Medicare beneficiaries aged 65 and older from 2011-2016. We included continuously enrolled beneficiaries with a history of Alzheimer’s disease and related dementias (ADRD) as defined by the Chronic Conditions Warehouse. We excluded patients who died, were transferred, observed, hospitalized, or discharged to a nursing facility or rehabilitation center. We identified characteristics associated with any non-ED ambulatory follow-up visit within 30 days, including beneficiary characteristics (age, sex, race, Medicaid eligibility), principal visit diagnosis category (using 38 categories designed for emergency care health services research), and hospital factors (size, region, urban/rural location, teaching status, ownership, safety-net status). We fit a Kaplan-Meier curve to estimate the time-dependent probability of ambulatory follow-up after ED discharge, treating death as a competing risk and 30 days as the censoring time. We fit a Cox regression model with time to follow-up as outcome, death as a competing risk, 30 days as the censoring time, and adjusted for all covariates and hospital-level clustering by stratifying by hospital. We performed 3 separate Cox regression models for mortality, ED revisits, and hospitalizations within 30 days of ED discharge, using the same specifications as the follow-up model and also including follow-up visit as a time-varying covariate. We conducted an observational study of ED visits resulting in discharge among Medicare beneficiaries aged 65 and older from 2011-2016. We included continuously enrolled beneficiaries with a history of Alzheimer’s disease and related dementias (ADRD) as defined by the Chronic Conditions Warehouse. We excluded patients who died, were transferred, observed, hospitalized, or discharged to a nursing facility or rehabilitation center. We identified characteristics associated with any non-ED ambulatory follow-up visit within 30 days, including beneficiary characteristics (age, sex, race, Medicaid eligibility), principal visit diagnosis category (using 38 categories designed for emergency care health services research), and hospital factors (size, region, urban/rural location, teaching status, ownership, safety-net status). We fit a Kaplan-Meier curve to estimate the time-dependent probability of ambulatory follow-up after ED discharge, treating death as a competing risk and 30 days as the censoring time. We fit a Cox regression model with time to follow-up as outcome, death as a competing risk, 30 days as the censoring time, and adjusted for all covariates and hospital-level clustering by stratifying by hospital. We performed 3 separate Cox regression models for mortality, ED revisits, and hospitalizations within 30 days of ED discharge, using the same specifications as the follow-up model and also including follow-up visit as a time-varying covariate. ResultsBetween 2011-2016, there were 2,075,085 ED discharges among beneficiaries with ADRD. Mean age was 82.3 years, 65.3% were women, 11.8% were Black, and 2.5% were Hispanic. The rate of ambulatory follow-up was 33.8% within 7 days and 62.8% within 30 days. With respect to outcomes, 2.8% died, 22.8% experienced an ED revisit, and 15% were hospitalized within 30 days. Characteristics associated with lower hazard of post-discharge ambulatory follow-up included Medicaid eligibility (HR 0.73, 95% CI 0.72-0.73; P<.001); Black race (HR 0.87, 95% CI 0.85-0.88; P<.001); treatment at a rural ED (HR 0.75, 95% CI 0.73-0.78; P<.001). After adjusting for patient and hospital characteristics, beneficiaries who completed ambulatory follow-up had a lower hazard of mortality (HR 0.43, 95% CI 0.42-0.44; P<.001), higher hazard of ED revisit (HR 1.06, 95% CI 1.06-1.07; P<.001) and higher hazard of hospitalization (HR 1.16, 95% CI 1.15-1.16; P<.001) within 30 days. Between 2011-2016, there were 2,075,085 ED discharges among beneficiaries with ADRD. Mean age was 82.3 years, 65.3% were women, 11.8% were Black, and 2.5% were Hispanic. The rate of ambulatory follow-up was 33.8% within 7 days and 62.8% within 30 days. With respect to outcomes, 2.8% died, 22.8% experienced an ED revisit, and 15% were hospitalized within 30 days. Characteristics associated with lower hazard of post-discharge ambulatory follow-up included Medicaid eligibility (HR 0.73, 95% CI 0.72-0.73; P<.001); Black race (HR 0.87, 95% CI 0.85-0.88; P<.001); treatment at a rural ED (HR 0.75, 95% CI 0.73-0.78; P<.001). After adjusting for patient and hospital characteristics, beneficiaries who completed ambulatory follow-up had a lower hazard of mortality (HR 0.43, 95% CI 0.42-0.44; P<.001), higher hazard of ED revisit (HR 1.06, 95% CI 1.06-1.07; P<.001) and higher hazard of hospitalization (HR 1.16, 95% CI 1.15-1.16; P<.001) within 30 days. ConclusionFollow-up care after ED discharge is associated with reduced mortality; however, one in three older adults with dementia lacks follow-up care within 30 days. Beneficiaries with dementia who are Black, eligible for Medicaid, and are treated at rural hospitals experience disproportionate barriers to accessing care, which exacerbates disparities in health outcomes for this vulnerable group.No, authors do not have interests to disclose Follow-up care after ED discharge is associated with reduced mortality; however, one in three older adults with dementia lacks follow-up care within 30 days. Beneficiaries with dementia who are Black, eligible for Medicaid, and are treated at rural hospitals experience disproportionate barriers to accessing care, which exacerbates disparities in health outcomes for this vulnerable group." @default.
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• W4297523778 date "2022-10-01" @default.
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• W4297523778 title "136 Ambulatory Follow-up After Emergency Department Discharge and Association With Outcomes Among Older Adults With Alzheimer’s Disease and Related Dementia" @default.
• W4297523778 doi "https://doi.org/10.1016/j.annemergmed.2022.08.160" @default.
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