Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland; Hospital And Public health interdisciPlinarY research (HAPPY) Lab, School of Public Health, University of Maryland, College Park, Maryland.
Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland; Hospital And Public health interdisciPlinarY research (HAPPY) Lab, School of Public Health, University of Maryland, College Park, Maryland.
Am J Prev Med. 2021 May;60(5):595-604. doi: 10.1016/j.amepre.2020.12.014. Epub 2021 Apr 6.
System-level care coordination strategies can be the most effective to promote continuity of care among people with Alzheimer's disease; however, the evidence is lacking. The objective of this study is to determine whether accountable care organizations are associated with lower rates of potentially preventable hospitalizations for people with Alzheimer's disease and whether hospital accountable care organization affiliation is associated with reduced racial and ethnic disparities in preventable hospitalizations among patients with Alzheimer's disease.
This study employed a cross-sectional study design and used 2015 Healthcare Cost and Utilization Project inpatient claims data from 11 states and the 2015 American Hospital Association Annual Survey. Logistic regression and the Blinder-Oaxaca decomposition method were used.
African American patients with Alzheimer's disease were less likely to be hospitalized at accountable care organization‒affiliated hospitals than White patients. Among patients with Alzheimer's disease who were hospitalized, hospital accountable care organization affiliation was associated with lower odds of potentially preventable hospitalizations (OR=0.86, p=0.02; OR=0.66, p<0.001 with propensity score matching) after controlling for patient characteristics, hospital characteristics, and state indicators. Hospital accountable care organization affiliation explained 3.01% (p<0.01) of the disparity in potentially preventable hospitalizations between White and African American patients but could not explain disparities between White and Latinx patients.
Evidence suggests that accountable care organizations may be able to improve care coordination for people with Alzheimer's disease and to reduce disparities between Whites and African Americans. Further research is needed to determine whether this benefit can be attributed to accountable care organization formation or whether providers that participate in accountable care organizations tend to provide higher-quality care.
系统级别的护理协调策略对于促进阿尔茨海默病患者的护理连续性可能是最有效的；然而，目前证据不足。本研究的目的是确定医疗保健责任组织是否与阿尔茨海默病患者潜在可预防住院率的降低相关，以及医院医疗保健责任组织的隶属关系是否与阿尔茨海默病患者的可预防住院率的种族和民族差异减少相关。
本研究采用了横断面研究设计，并使用了来自 11 个州的 2015 年医疗保健成本和利用项目住院患者数据和 2015 年美国医院协会年度调查数据。采用了逻辑回归和 Blinder-Oaxaca 分解方法。
与白人患者相比，患有阿尔茨海默病的非裔美国患者在医疗保健责任组织附属医院住院的可能性较小。在患有阿尔茨海默病并住院的患者中，在控制了患者特征、医院特征和州指标后，医院医疗保健责任组织的隶属关系与潜在可预防住院的可能性降低相关（OR=0.86，p=0.02；OR=0.66，p<0.001，采用倾向评分匹配）。医院医疗保健责任组织的隶属关系解释了白人患者和非裔美国患者之间潜在可预防住院率差异的 3.01%（p<0.01），但无法解释白人患者和拉丁裔患者之间的差异。
有证据表明，医疗保健责任组织可能能够改善阿尔茨海默病患者的护理协调，并减少白人和非裔美国人之间的差异。需要进一步研究以确定这种益处是否归因于医疗保健责任组织的形成，或者参与医疗保健责任组织的提供者是否倾向于提供更高质量的护理。
