Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Dr, College Park, MD 20742, USA.
Department of Health Policy and Management, University of Maryland School of Public Health, 4200 Valley Dr, College Park, MD 20742, USA.
Prev Med. 2022 Oct;163:107223. doi: 10.1016/j.ypmed.2022.107223. Epub 2022 Aug 23.
We examined urban and rural disparities in potentially preventable hospitalizations (PPHs) among US patients with Alzheimer's Disease and Related Dementias (ADRD) and the use of telehealth post-discharge and enabling services as mediators. We merged 2017 100% Medicare Fee-For-Service (FFS) claims with the Medicare Beneficiary Summary File, along with population and hospital-based characteristics. Logistic regression models were employed to examine differences in PPHs by telehealth and enabling services. The rates of PPHs related to acute and chronic conditions for patients with ADRD living in rural and micropolitan areas were significantly higher compared to patients with ADRD in urban areas. Telehealth post-discharge combined with enabling services significantly decreased the odds of PPHs associated with acute (OR: 0.93, 95% CI: 0.89-0.98, P-value <0.01) and chronic conditions (OR: 0.96, 95% CI: 0.92-1.00, P-value = 0.07). In addition, telehealth post-discharge combined with enabling services significantly decreased the odds of PPHs in patients with ADRD in rural (acute PPHs OR: 0.56, 95% CI: 0.41-0.77, P-value <0.01; chronic PPHs OR: 0.73, 95% CI: 0.55-0.97, P-value = 0.03) and micropolitan (acute PPHs OR: 0.65, 95% CI: 0.57-0.73, P-value <0.01; chronic PPHs OR: 0.83, 95% CI: 0.74-0.93, P-value <0.01) areas. Our results suggest that the combinations of telehealth post-discharge and enabling services are important interventions in helping to reduce preventable hospitalizations among patients with ADRD living in rural and micropolitan areas.
我们研究了美国患有阿尔茨海默病及相关痴呆症（ADRD）的患者中，城乡之间潜在可预防住院治疗（PPH）的差异，以及出院后使用远程医疗和使能服务作为中介的情况。我们将 2017 年 100%的医疗保险按服务付费（FFS）索赔与医疗保险受益摘要文件以及人口和医院特征合并。使用逻辑回归模型检查远程医疗和使能服务与 PPH 差异。与城市地区的 ADRD 患者相比，居住在农村和小城市地区的 ADRD 患者与急性和慢性疾病相关的 PPH 发生率明显更高。出院后结合远程医疗和使能服务可显著降低与急性（OR：0.93，95%CI：0.89-0.98，P 值<0.01）和慢性疾病（OR：0.96，95%CI：0.92-1.00，P 值=0.07）相关的 PPH 发生几率。此外，出院后结合远程医疗和使能服务可显著降低农村（急性 PPH OR：0.56，95%CI：0.41-0.77，P 值<0.01；慢性 PPH OR：0.73，95%CI：0.55-0.97，P 值=0.03）和小城市（急性 PPH OR：0.65，95%CI：0.57-0.73，P 值<0.01；慢性 PPH OR：0.83，95%CI：0.74-0.93，P 值<0.01）地区 ADRD 患者的 PPH 发生率。我们的研究结果表明，出院后远程医疗和使能服务的结合是帮助减少农村和小城市地区 ADRD 患者可预防住院治疗的重要干预措施。
