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听力、视力及双重感官丧失的成年人中潜在可预防的住院情况:一项病例对照研究。

Potentially Preventable Hospitalization Among Adults with Hearing, Vision, and Dual Sensory Loss: A Case and Control Study.

作者信息

Ratakonda Samantha, Lin Paul, Kamdar Neil, Meade Michelle, McKee Michael, Mahmoudi Elham

机构信息

Tulane University School of Medicine, New Orleans, LA.

Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, MI.

出版信息

Mayo Clin Proc Innov Qual Outcomes. 2023 Jul 21;7(4):327-336. doi: 10.1016/j.mayocpiqo.2023.06.004. eCollection 2023 Aug.

Abstract

OBJECTIVE

To evaluate the risk of potentially preventable hospitalizations (PPHs) among adults with sensory loss. We hypothesized a greater PPH risk among people with a sensory loss (hearing, vision, and dual) compared with controls.

PATIENTS AND METHODS

Using 2007-2016 Medicare fee-for-service claims, this retrospective, case-control study examined the risk of PPH among adults aged 65 years and older with hearing, vision, and dual sensory loss compared with their corresponding counterparts without sensory loss (between June 1, 2022, and February 1, 2023). We ran 3 step-in regression models for the 3 case and control cohorts examining PPH risk. Our generalized linear regression models controlled for age, sex, race, Elixhauser comorbidity count, rurality, neighborhood characteristics, and the number of primary care physicians and hospitals at the county level.

RESULTS

People with vision (adjusted odds ratio [aOR], 1.21; 95% CI, 0.84-0.87) and dual sensory loss (aOR, 1.26; 95% CI, 1.14-1.40) showed a higher PPH risks than their corresponding controls. For people with hearing loss, our unadjusted models showed a higher PPH risk (OR, 1.40; 95% CI, 1.38-1.43) but after adjustment, hearing loss showed a protective association against PPH risk (OR, 0.85; 95% CI, 0.84-0.87). Moreover, in all models, annual wellness visits reduced the PPH risk by about half (eg, aOR, 0.54; 95% CI, 0.52-0.55), whereas living in disadvantaged neighborhood increased the PPH risk (eg, aOR, 1.13; 95% CI, 1.10-1.15) for cases and controls.

CONCLUSION

People with vision and dual sensory loss were at greater PPH risk. This study has important health policy implications in reducing PPH and is indicative of a need for more incentivized and systematic approaches to facilitating the use of preventive care, particularly among older adults living in a disadvantaged neighborhood.

摘要

目的

评估成年感觉丧失者中潜在可预防住院(PPH)的风险。我们假设与对照组相比,感觉丧失(听力、视力及双重感觉丧失)者的PPH风险更高。

患者与方法

利用2007 - 2016年医疗保险按服务付费索赔数据,这项回顾性病例对照研究考察了65岁及以上有听力、视力及双重感觉丧失的成年人与相应无感觉丧失的成年人相比的PPH风险(2022年6月1日至2023年2月1日期间)。我们针对3个病例组和对照组队列运行了3个逐步回归模型来考察PPH风险。我们的广义线性回归模型对年龄、性别、种族、埃利克斯豪泽合并症计数、农村地区、社区特征以及县级初级保健医生和医院数量进行了控制。

结果

视力丧失者(调整后比值比[aOR],1.21;95%置信区间[CI],0.84 - 0.87)和双重感觉丧失者(aOR,1.26;95% CI,1.14 - 1.40)的PPH风险高于相应对照组。对于听力丧失者,我们的未调整模型显示PPH风险较高(比值比[OR],1.40;95% CI,1.38 - 1.43),但调整后,听力丧失与PPH风险呈保护关联(OR,0.85;95% CI,0.84 - 0.87)。此外,在所有模型中,年度健康检查使PPH风险降低约一半(例如,aOR,0.54;95% CI,0.52 - 0.55),而生活在弱势社区会增加病例组和对照组的PPH风险(例如,aOR,1.13;95% CI,1.10 - 1.15)。

结论

视力丧失者和双重感觉丧失者的PPH风险更高。本研究对降低PPH具有重要的卫生政策意义,表明需要采取更具激励性和系统性的方法来促进预防性保健的使用,特别是在生活在弱势社区的老年人中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e8df/10391598/290bc7d48c40/gr1.jpg

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