The Division of Health Systems Management and Policy, School of Public Health, The University of Memphis, Memphis, 133 Robison Hall, Memphis, TN, 38152, USA.
Center for Population Health and Aging, Texas A&M University, College Station, 212 Adriance Lab Rd, 1266 TAMU, College Station, TX, 77843, USA.
BMC Health Serv Res. 2020 Feb 3;20(1):77. doi: 10.1186/s12913-020-4902-7.
The Affordable Care Act (ACA) was enacted to enhance access to care primarily among nonelderly and low-income populations; however, several provisions addressed key determinants of emergency department (ED) and inpatient visits among Medicare beneficiaries over age 65 years. We take stock of the overall changes in these visits among older Medicare beneficiaries, focusing on those with multiple chronic conditions (MCCs), and provide a nationally representative post-reform update.
We analyzed a sample of 32,919 older adults (65+) on Medicare from the 2006-2015 Medical Expenditure Panel Survey (MEPS). Using a survey-weighted two-part model, we examined changes in ED visits, inpatient visits, and length of stay (LOS) by MCC status, before (2006-2010), during (2011-2013), and after the ACA (2014-2015).
Prior to the ACA, 18.1% of Medicare older adults had ≥1 ED visit, whereas 17.1% had ≥1 inpatient visits, with an average of 5.1 nights/visit. Following ACA reforms, among those with 2+ chronic conditions, the rate of ever having an ED visit increased by 4.3 percentage points [95% confidence intervals [CI]: 2.5, 6.1, p < 0.01], whereas the rate of inpatient visits decreased by 1.4 percentage points [95%CI: - 2.9, 0.2, p < 0.1], after multivariable adjustment.
We found sizable increases in ED visits and nontrivial decreases in inpatient visits among older Medicare beneficiaries with MCCs, underscoring the continuing need for improving access to and quality of care among older adults with MCCs to decrease reliance on the ED and reduce preventable hospitalizations.
平价医疗法案（ACA）的颁布主要是为了增加非老年和低收入人群的医疗服务可及性；然而，该法案的一些条款也涉及到了 Medicare 受益人的急诊室（ED）和住院访问的关键决定因素。我们对 Medicare 老年受益人的这些访问总体变化进行了评估，重点关注患有多种慢性疾病（MCC）的患者，并提供了具有代表性的改革后更新。
我们分析了 2006 年至 2015 年医疗支出面板调查（MEPS）中 Medicare 32919 名老年患者（65 岁以上）的样本。使用经过调查加权的两部分模型，我们根据 MCC 状态，在平价医疗法案（ACA）之前（2006-2010 年）、期间（2011-2013 年）和之后（2014-2015 年），研究了 ED 访问、住院访问和住院时间（LOS）的变化。
在 ACA 之前，18.1%的 Medicare 老年患者有≥1 次 ED 就诊，17.1%有≥1 次住院就诊，平均每次就诊 5.1 晚。在 ACA 改革之后，在有 2 种以上慢性疾病的患者中，ED 就诊的终身就诊率增加了 4.3 个百分点[95%置信区间[CI]：2.5，6.1，p<0.01]，而住院就诊率下降了 1.4 个百分点[95%CI：-2.9，0.2，p<0.1]，这是在多变量调整后。
我们发现，患有 MCC 的 Medicare 老年受益人的 ED 就诊人数显著增加，而住院就诊人数略有减少，这强调了继续需要改善患有 MCC 的老年人的医疗服务可及性和质量，以减少对 ED 的依赖并减少可预防的住院治疗。
