Mahmoudi Elham, Margosian Sara, Lin Paul
Department of Family Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.
J Gerontol B Psychol Sci Soc Sci. 2024 Jul 1;79(7). doi: 10.1093/geronb/gbae078.
Examine racial/ethnic disparities in 30-day readmission and frequent hospitalizations among Medicare beneficiaries with dementia in traditional Medicare (TM) versus Medicare Advantage (MA).
In this case-control study, we used 2018-2019 TM and MA claims data. Participants included individuals 65+ with 2 years of continuous enrollment, diagnosis of dementia, a minimum of 4 office visits in 2018, and at least 1 hospitalization in 2019, (cases: TM [n = 36,656]; controls: MA [n = 29,366]). We conducted matching based on health-need variables and applied generalized linear models adjusting for demographics, health-related variables, and healthcare encounters.
TM was associated with higher odds of 30-day readmission (OR = 1.07 [CI: 1.02 to 1.12]) and frequent hospitalizations (OR = 1.10 [CI: 1.06 to 1.14]) compared to MA. Hispanic and Black enrollees in TM had higher odds of frequent hospitalizations compared with Hispanic and Black enrollees in MA, respectively (OR = 1.35 [CI: 1.19 to 1.54]) and (OR = 1.26 [CI: 1.13 to 1.40]). MA was associated with lower Hispanic-White and Black-White disparities in frequent hospitalizations by 5.8 (CI: -0.09 to -0.03) and 4.4 percentage points (PP; CI: -0.07 to -0.02), respectively. For 30-day readmission, there was no significant difference between Black enrollees in TM and MA (OR = 1.04 [CI: 0.92 to 1.18]), but Hispanic enrollees in TM had higher odds of readmission than Hispanics in MA (OR = 1.23 [CI: 1.06 to 1.43]). MA was associated with a lower Hispanic-White disparity in readmission by 1.9 PP (CI: -0.004 to -0.01).
MA versus TM was associated with lower risks of 30-day readmission and frequent hospitalizations. Moreover, MA substantially reduced Hispanic-White and Black-White disparities in frequent hospitalizations compared with TM.
研究传统医疗保险（TM）与医疗保险优势计划（MA）中患有痴呆症的医疗保险受益人的30天再入院率和频繁住院情况的种族/民族差异。
在这项病例对照研究中，我们使用了2018 - 2019年的TM和MA索赔数据。参与者包括65岁及以上连续参保2年、被诊断患有痴呆症、2018年至少有4次门诊就诊且2019年至少有1次住院治疗的个体（病例：TM [n = 36,656]；对照：MA [n = 29,366]）。我们根据健康需求变量进行匹配，并应用广义线性模型对人口统计学、健康相关变量和医疗接触情况进行调整。
与MA相比，TM与30天再入院率较高（OR = 1.07 [CI：1.02至1.12]）和频繁住院率较高（OR = 1.10 [CI：1.06至1.14]）相关。TM中的西班牙裔和黑人参保者与MA中的西班牙裔和黑人参保者相比，分别有更高的频繁住院几率（OR = 1.35 [CI：1.19至1.54]）和（OR = 1.26 [CI：1.13至1.40]）。MA与频繁住院中西班牙裔 - 白人以及黑人 - 白人之间的差异分别降低5.8个百分点（CI：-0.09至-0.03）和4.4个百分点（PP；CI：-0.07至-0.02）相关。对于30天再入院率，TM中的黑人参保者和MA中的黑人参保者之间没有显著差异（OR = 1.04 [CI：0.92至1.18]），但TM中的西班牙裔参保者比MA中的西班牙裔有更高的再入院几率（OR = 1.23 [CI：1.06至1.43]）。MA与再入院中西班牙裔 - 白人之间的差异降低1.9个百分点（CI：-0.004至-0.01）相关。
与TM相比，MA与30天再入院率和频繁住院的风险较低相关。此外，与TM相比，MA显著降低了频繁住院中西班牙裔 - 白人和黑人 - 白人之间的差异。
