Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.
Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
J Am Geriatr Soc. 2024 May;72(5):1442-1452. doi: 10.1111/jgs.18890. Epub 2024 Mar 28.
There has been a marked rise in the use of observation care for Medicare beneficiaries visiting the emergency department (ED) in recent years. Whether trends in observation use differ for people with Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) is unknown.
Using a national 20% sample of Medicare beneficiaries ages 68+ from 2012 to 2018, we compared trends in ED visits and observation stays by AD/ADRD status for beneficiaries visiting the ED. We then examined the degree to which trends differed by nursing home (NH) residency status, assigning beneficiaries to four groups: AD/ADRD residing in NH (AD/ADRD+ NH+), AD/ADRD not residing in NH (AD/ADRD+ NH-), no AD/ADRD residing in NH (AD/ADRD- NH+), and no AD/ADRD not residing in NH (AD/ADRD- NH-).
Of 7,489,780 unique beneficiaries, 18.6% had an AD/ADRD diagnosis. Beneficiaries with AD/ADRD had more than double the number of ED visits per 1000 in all years compared to those without AD/ADRD and saw a faster adjusted increase over time (+26.7 vs. +8.2 visits/year; p < 0.001 for interaction). The annual increase in the adjusted proportion of ED visits ending in observation was also greater among people with AD/ADRD (+0.78%/year, 95% CI 0.77-0.80%) compared to those without AD/ADRD (+0.63%/year, 95% CI 0.59-0.66%; p < 0.001 for interaction). Observation utilization was greatest for the AD/ADRD+ NH+ population and lowest for the AD/ADRD- NH- population, but the AD/ADRD+ NH- group saw the greatest increase in observation stays over time (+15.4 stays per 1000 people per year, 95% CI 15.0-15.7).
Medicare beneficiaries with AD/ADRD have seen a disproportionate increase in observation utilization in recent years, driven by both an increase in ED visits and an increase in the proportion of ED visits ending in observation.
近年来，在医疗保险受益人群中，因急诊（ED）就诊而接受观察护理的人数显著增加。目前尚不清楚阿尔茨海默病和相关痴呆症（AD/ADRD）患者的观察使用趋势是否存在差异。
我们使用了 2012 年至 2018 年医疗保险受益人的全国 20%抽样数据，比较了 ED 就诊的 AD/ADRD 状态对 ED 就诊和观察住院的影响。然后，我们检查了这些趋势在疗养院（NH）居住状态上的差异程度，将受益人群分为四组：居住在 NH 的 AD/ADRD（AD/ADRD+NH+）、不居住在 NH 的 AD/ADRD（AD/ADRD+NH-）、不居住在 NH 的非 AD/ADRD（AD/ADRD-NH+）和不居住在 NH 的非 AD/ADRD（AD/ADRD-NH-）。
在 7489780 名独特的受益人群中，18.6%的人患有 AD/ADRD。在所有年份中，患有 AD/ADRD 的受益人群的 ED 就诊次数是没有 AD/ADRD 的受益人群的两倍以上，并且观察到就诊人数随时间呈快速调整增长（+26.7 次/年与+8.2 次/年；交互作用 p<0.001）。AD/ADRD 患者 ED 就诊结束时观察比例的年增长率也高于无 AD/ADRD 患者（+0.78%/年，95%CI 0.77-0.80%）（交互作用 p<0.001）。AD/ADRD+NH+人群的观察使用率最高，AD/ADRD-NH-人群的观察使用率最低，但 AD/ADRD+NH-人群的观察住院人数随时间的增长幅度最大（每年每 1000 人增加 15.4 次，95%CI 15.0-15.7）。
近年来，患有 AD/ADRD 的医疗保险受益人群的观察使用率出现了不成比例的增长，这是由于 ED 就诊次数的增加和 ED 就诊结束时观察比例的增加所致。
