P2‐433: 30‐Day Hospital Readmissions Among Medicare Beneficiaries With Alzheimer’s Disease and Related Dementias Prior to and Following Diagnosis

Abstract

Prior to receiving a formal diagnosis of Alzheimer’s disease and related dementias (ADRD), patients may begin using more health care services and accruing high costs, especially for inpatient care. This study examined hospital quality of care, as measured by 30-day readmission rates, among Medicare beneficiaries with ADRD before and after diagnosis. Using data from the 5% sample of 2009-2013 Medicare claims, we identified 25,916 newly-diagnosed ADRD patients and an equal number of propensity-score matched control subject without cognitive impairment or dementia. We analyzed Medicare expenditures, health care utilization, and 30-day readmission rates during the 24 months before and 24 months after a new ADRD diagnosis. During the 13-24 pre-diagnosis months, 12% of ADRD patients were readmitted to the hospital within 30 days of discharge, compared with 10% among controls. ADRD patients continued to have more 30-day readmissions than controls as the disease progressed: 15% vs. 11% in the year prior to diagnosis, 16% vs. 11% in the year following diagnosis, and 16% vs. 13% in the second year after diagnosis. Many ADRD patients were readmitted following a hospitalization for acute myocardial infarction, heart failure, pneumonia, chronic obstructive pulmonary disease, and stroke—conditions that are targeted by the CMS Hospital Readmission Reduction Program. Compared with matched controls, ADRD patients had longer lengths of stay and used more inpatient, post-acute skilled nursing facility, and home health both before and after diagnosis. Total Medicare expenditures were 42% higher among ADRD patients during the year prior to diagnosis ($10,622 vs. $15,091, p<0.001), and 192% higher during the first year immediately following diagnosis ($9,274 vs. $27,126, p<0.001). We found that many newly-diagnosed ADRD patients are readmitted to the hospital within 30 days of discharge, and that they have more costly 30-day readmissions for acute exacerbations of chronic diseases and higher Medicare expenditures than controls during the periods before and following diagnosis. Our findings show that the impact of cognitive impairment on hospitalizations may be mediated through poor management of comorbidities. Early recognition of ADRD as well as improved post-discharge planning and care coordination are needed to reduce readmissions among ADRD patients. Trends in quarterly Medicare expenditures prior to and following diagnosis among ADRD and matched control subjects. Proportion of patients with all-cause 30-day readmissions.