scholarly journals Health Care Utilization in Diverse Older Adults in the Deep South and the Rest of the United States

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 100-101
Author(s):  
Maria Pisu ◽  
Roy Martin ◽  
Liang Shan ◽  
Giovanna Pilonieta ◽  
Richard Kennedy ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
The United States ◽  
Care Utilization ◽  
Deep South ◽  
Medicare Beneficiaries ◽  
Health Care Outcomes ◽  
Utilization Data ◽  
One Year

Abstract We examined racial/ethnic (R/E) differences in health care utilization among older adults with Alzheimer’s disease and related dementia (ADRD) from US Deep South [DS] and non-DS, and individual or context-level factors that affect this utilization. Data were 2013-2015 claims for Medicare beneficiaries with ADRD; county-level data were used to define context-level covariates; adjusted analyses were conducted separately for DS and non-DS. Across R/E groups, 33%-43% in DS, 43%-50% in non-DS used ADRD specialists; 47%-55% in DS, 41%-48% in non-DS used ADRD drugs; 42.9%-53.4% in DS, 42%-51.8% in non-DS had hospitalizations in a one-year follow-up. R/E differences were not significant, with few exceptions. Comorbidities, poverty, and medical resources availability were associated with specialist use and hospitalizations; comorbidities and specialist use were associated with drug use. In non-DS only, other individual, context-level covariates were associated with health care outcomes. Research should further examine determinants of health care utilization in these populations.

Trends in health care utilization, cost, and aggressive care at end of life among older cancer patients in the Deep South.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 155-155
Author(s):  
Elizabeth Ann Kvale ◽  
Gabrielle Rocque ◽  
Kerri S. Bevis ◽  
Aras Acemgil ◽  
Richard A. Taylor ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
End Of Life ◽  
Healthcare Utilization ◽  
Linear Models ◽  
Care Utilization ◽  
Deep South ◽  
Medicare Beneficiaries ◽  
Aggressive Care ◽  
The Impact

155 Background: Healthcare utilization and costs escalate near diagnosis and in the final months of life. There is a national trend toward aggressive care at end of life (EOL). We examined patterns in utilization and cost across the trajectory of care and during the last two weeks of life during implementation of a lay navigation intervention. Methods: Claims data were obtained for Medicare beneficiaries ≥ 65 years old with cancer in the UAB Health System Cancer Community Network (UAB CCN). For 10 quarters from January 2012 -June 2014, we examined healthcare utilization for the population at large, navigated patients, and decedents. All analyses included ER visits, hospitalizations, and ICU admissions and use of chemotherapy in the last 2 weeks of life, and hospice utilization (admission or less than 3 days of hospice) in the quarter of death for decedents. Descriptive analyses and linear regression were used to test trends over time; general linear models evaluated changes in health care utilization and cost. Results: Across the population reduction of 13.4% to 11% for hospitalization (18% decrease, p < 0.01), 8.0% to 7.1% for ER visits (12% decrease, p < 0.01), 2.9% to 2.5% for ICU admissions (14% decrease, p = 0.04) and an increase of 3.9% to 4.3% for hospice (9.2% increase p = 0.37) were found. Among 5,861 decedents, in the last 2 weeks of life, there were decreases in ICU admissions (14.6% decrease, p = 0.11), from 39.2% to 32.0%, ER visits (18.4% decrease, p = 0.03), and chemotherapy, from 4.7% to 3.5% (25.5% decrease, p = 0.11).Over the 10 quarters, hospice enrollment increased from 70.7% to 77.4% (9.48% increase; p = 0.06), and the proportion of patients on hospice for less than 3 days changed from 7.8% to 7.5% (3.85% decrease, p = 0.30). Costs decreased about $158 per quarter per beneficiary. A significant pre-post decrease of $952 per beneficiary (p < 0.01) led to an estimated reduction in Medicare costs of $18,406,920 for the 19,335 beneficiaries in the UAB CCN for the five quarters post-implementation. Conclusions: We observed decreased healthcare utilization and cost and trends toward decreased aggressive care at EOL in the UAB CCN. Further work is needed to determine the impact of navigation on utilization trends.

scholarly journals Health Care Utilization Among Elderly Medicare Beneficiaries With Coexisting Dementia and Cancer

2017 ◽  
Vol 3 ◽  
pp. 233372141668904 ◽  
Author(s):  
Satish K. Kedia ◽  
Prachi P. Chavan ◽  
Sarah E. Boop ◽  
Xinhua Yu
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Financial Burden ◽  
Hospital Readmissions ◽  
The United States ◽  
Emergency Department Visits ◽  
Care Utilization ◽  
Study Cohort ◽  
Medicare Beneficiaries ◽  
Care Plans

Objective: The goal of this research is to delineate health care utilization among elderly Medicare beneficiaries with coexisting dementia and cancer compared with those with dementia alone, cancer alone, or neither condition. Method: The study cohort included 96,124 elderly patients aged 65 years and older who resided in the Mid-South region of the United States and were enrolled in Medicare during 2009. Multivariate regression analyses were used to examine health care utilizations while adjusting for sociodemographic characteristics. Results: Those with coexisting dementia and cancer diagnoses had higher rates of hospitalizations, hospital readmissions within 30 days, intensive care unit use, and emergency department visits compared with those with dementia only, cancer only, and those with neither condition. Patients with coexisting dementia and cancer also had a higher number of primary care visits and specialist visits. Conclusion: There is a greater need for developing tailored care plans for elderly with these two degenerative health conditions to address their unique health care needs and to reduce financial burden on the patients and the health care system.

scholarly journals Alternative Pathways for Hearing Care May Address Disparities in Access

2021 ◽  
Vol 3 ◽  
Author(s):  
Amber Willink ◽  
Lama Assi ◽  
Carrie Nieman ◽  
Catherine McMahon ◽  
Frank R. Lin ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Hearing Loss ◽  
Health Care Utilization ◽  
Hearing Aids ◽  
Hearing Aid ◽  
Care Utilization ◽  
Medicare Beneficiaries ◽  
Hearing Aid Use ◽  
The U.S

Background/Objectives: Low-uptake of hearing aids among older adults has long dogged the hearing care system in the U.S. and other countries. The introduction of over-the-counter hearing aids is set to disrupt the predominantly high-cost, specialty clinic-based delivery model of hearing care with the hope of increasing accessibility and affordability of hearing care. However, the current model of hearing care delivery may not be reaching everyone with hearing loss who have yet to use hearing aids. In this study, we examine the group of people who do not use hearing aids and describe their characteristics and health care utilization patterns. We also consider what other healthcare pathways may be utilized to increase access to hearing treatment.Design: Cross-sectional, the 2017 Medicare Current Beneficiary Survey.Setting: Non-institutionalized adults enrolled in Medicare, the U.S. public health insurance program for older adults (65 years and older) and those with qualifying medical conditions and disabilities.Participants: A nationally representative sample of 7,361 Medicare beneficiaries with self-reported trouble hearing and/or hearing aid use.Measurements: Survey-weighted proportions described the population characteristics and health care utilization of those with hearing loss by hearing aid use, and the characteristics of those with untreated hearing loss by health care service type utilized.Results: Women, racial/ethnic minorities, and low-income Medicare beneficiaries with self-reported hearing trouble were less likely to report using hearing aids than their peers. Among those who do not use hearing aids, the most commonly used health care services were obtaining prescription drugs (64%) and seeing a medical provider (50%). Only 20% did not access either service in the past year. These individuals were more likely to be young and to have higher educational attainment and income.Conclusion: Alternative models of care delivered through pharmacies and general medical practices may facilitate access to currently underserved populations as they are particularly high touch-points for Medicare beneficiaries with untreated hearing trouble. As care needs will vary across a spectrum of hearing loss, alternative models of hearing care should look to complement not substitute for existing access pathways to hearing care.

scholarly journals The Use of Online Health-Management Tools and Health Care Utilization Among Older Americans

2020 ◽  
Vol 60 (7) ◽  
pp. 1224-1232
Author(s):  
Darren Liu ◽  
Takashi Yamashita ◽  
Betty Burston ◽  
Jennifer R Keene
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Health Care Utilization ◽  
Digital Divide ◽  
Technology Use ◽  
Health Management ◽  
The United States ◽  
Care Utilization ◽  
Management Tools ◽  
Health Related

Abstract Background and Objectives The digital divide, or differences in access to technology, can have far-reaching consequences. This study identified disparities in access to online health-related technology. It then investigated associations between online health-related technology use and health care utilization among older adults in the United States. Research Design and Methods The study used a cross-sectional data set of 1,497 adults aged 51 and older from the 2014 Health and Retirement Study (HRS)’s supplemental module (Health Behaviors) and the RAND version of the HRS fat file. Results Older age, being a racial/ethnic minority, married, uninsured, and having lower educational attainment, lower income, and reporting poorer health were each associated with lower levels of use of online health-management tools. The use of online health-management tools was associated with a 34% greater mean number of doctor visits (incidence rate ratio = 1.34, SE = 0.10, p &lt; .05) than nonuse. However, such use was not associated with the number or type of hospitalizations. Indeed, only health care needs as measured by self-rated health status (odds ratio [OR] = 0.58, SE = 0.18, p &lt; .05) and the number of chronic conditions were associated with hospitalizations (OR = 1.68, SE = 0.07, p &lt; .05). Discussion and Implications While more research is needed to clarify the purposes (e.g., prevention vs. treatment) and outcomes of health care service utilization as a function of technology use, it may be wise to proactively tackle the digital divide as one upstream strategy for improving various health and health care outcomes among older adults.

scholarly journals The Predictive Power of State-Level Health Care Utilization for Unintentional Fatal Fall Rates

2021 ◽  
Author(s):  
Matthew Gordon Crowson ◽  
Jason A. Beyea ◽  
Justin Cottrell ◽  
Faisal Karmali ◽  
Giovanni Lampasona ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Predictive Power ◽  
State Level ◽  
The United States ◽  
Care Utilization ◽  
Death Rates ◽  
Utilization Data ◽  
Age Adjusted Rates ◽  
Unintentional Falls

Abstract ObjectiveTo examine the predictive power of state-level care utilization and longitudinal trends in mortality from unintentional falls amongst different demographic and geographic strata.Study DesignNationwide, retrospective cohort study.SettingWeb-based Injury Statistics Query and Reporting System (WISQARS) database.MethodsThe exposure was death from an unintentional fall as determined by the United States Centers for Disease Control. Outcomes included aggregate and trend crude and age adjusted death rates. Health care utilization, reimbursement, and cost metrics were also compared.ResultsOver 2001 to 2018, 465,486 total deaths due to unintentional falls were recorded with crude and age-adjusted rates of 8.42 and 7.76 per 100,000 population. Comparing age-adjusted rates, males had a significantly higher age-adjusted death rate (9.89 vs. 6.17; p < 0.00001), but both male and female annual age-adjusted mortality rates are expected to rise (Male: +0.25 rate/year, R 2 = 0.98; Female: +0.22 rate/year, R 2 = 0.99). There were significant increases in death rates commensurate with increasing age, with the adults aged 85 years or older having the highest aggregate (201.1 per 100,000) and trending death rates (+ 8.75 deaths per 100,000/year, R 2 = 0.99). Machine learning algorithms using health care utilization data were accurate in predicting state-level age-adjusted death rates.ConclusionIn the United States from 2001 through 2018, older adults carried the highest death rate from unintentional falls and this rate is forecasted to accelerate. Machine learning models have high accuracy in predicting state-level age-adjusted mortality rates from health care utilization data.

Health Outcomes and Health Care Utilization Among Obstetric Deliveries With Concurrent CKD in the United States

2020 ◽  
Vol 75 (1) ◽  
pp. 148-150 ◽  
Author(s):  
Andrea L. Oliverio ◽  
Lindsay K. Admon ◽  
Laura H. Mariani ◽  
Tyler N.A. Winkelman ◽  
Vanessa K. Dalton
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care Utilization ◽  
Health Outcomes ◽  
The United States ◽  
Care Utilization

scholarly journals Health status and health care utilization after discharge from geriatric in-hospital stay – description of a register-based study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
E. Rydwik ◽  
R. Lindqvist ◽  
C. Willers ◽  
L. Carlsson ◽  
G. H. Nilsson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Status ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Future Studies ◽  
Healthcare Data ◽  
Utilization Data ◽  
Hospital Stays ◽  
Socioeconomic Data

Abstract Background This study is the first part of a register-based research program with the overall aim to increase the knowledge of the health status among geriatric patients and to identify risk factors for readmission in this population. The aim of this study was two-fold: 1) to evaluate the validity of the study cohorts in terms of health care utilization in relation to regional cohorts; 2) to describe the study cohorts in terms of health status and health care utilization after discharge. Methods The project consist of two cohorts with data from patient records of geriatric in-hospital stays, health care utilization data from Stockholm Regional Healthcare Data Warehouse 6 months after discharge, socioeconomic data from Statistics Sweden. The 2012 cohort include 6710 patients and the 2016 cohort, 8091 patients; 64% are women, mean age is 84 (SD 8). Results Mean days to first visit in primary care was 12 (23) and 10 (19) in the 2012 and 2016 cohort, respectively. Readmissions to hospital was 38% in 2012 and 39% in 2016. The validity of the study cohorts was evaluated by comparing them with regional cohorts. The study cohorts were comparable in most cases but there were some significant differences between the study cohorts and the regional cohorts, especially regarding amount and type of primary care. Conclusion The study cohorts seem valid in terms of health care utilization compared to the regional cohorts regarding hospital care, but less so regarding primary care. This will be considered in the analyses and when interpreting data in future studies based on these study cohorts. Future studies will explore factors associated with health status and re-admissions in a population with multi-morbidity and disability.

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