LaMantia Michael A, Stump Timothy E, Messina Frank C, Miller Douglas K, Callahan Christopher M
*Indiana University Center for Aging Research †Regenstrief Institute Inc. ‡Indiana University School of Medicine, Indianapolis, IN.
Alzheimer Dis Assoc Disord. 2016 Jan-Mar;30(1):35-40. doi: 10.1097/WAD.0000000000000118.
Although persons with dementia are frequently hospitalized, relatively little is known about the health profile, patterns of health care use, and mortality rates for patients with dementia who access care in the emergency department (ED). We linked data from our hospital system with Medicare and Medicaid claims, Minimum Data Set, and Outcome and Assessment Information Set data to evaluate 175,652 ED visits made by 10,354 individuals with dementia and 15,020 individuals without dementia over 11 years. Survival rates after ED visits and associated charges were examined. Patients with dementia visited the ED more frequently, were hospitalized more often than patients without dementia, and had an increased odds of returning to the ED within 30 days of an index ED visit compared with persons who never had a dementia diagnosis (odds ratio, 2.29; P<0.001). Survival rates differed significantly between patients by dementia status (P<0.001). Mean Medicare payments for ED services were significantly higher among patients with dementia. These results show that older adults with dementia are frequent ED visitors who have greater comorbidity, incur higher charges, are admitted to hospitals at higher rates, return to EDs at higher rates, and have higher mortality after an ED visit than patients without dementia.
尽管痴呆症患者经常住院，但对于在急诊科就诊的痴呆症患者的健康状况、医疗保健使用模式和死亡率，我们了解得相对较少。我们将医院系统的数据与医疗保险和医疗补助索赔、最低数据集以及结果与评估信息集数据相链接，以评估10354名痴呆症患者和15020名非痴呆症患者在11年期间进行的175652次急诊科就诊情况。我们检查了急诊科就诊后的生存率及相关费用。与从未被诊断为痴呆症的人相比，痴呆症患者更频繁地前往急诊科，住院频率更高，且在首次急诊科就诊后30天内返回急诊科的几率增加（比值比为2.29；P<0.001）。根据痴呆症状态，患者之间的生存率存在显著差异（P<0.001）。痴呆症患者的急诊科服务平均医疗保险支付费用显著更高。这些结果表明，与非痴呆症患者相比，患有痴呆症的老年人是急诊科的常客，他们有更多的合并症，费用更高，住院率更高，返回急诊科的比率更高，且在急诊科就诊后的死亡率更高。
