 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Richard H. Fortinsky, PhD and Juliane R. Fenster, MS, MPH. University of Connecticut Center on Aging, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-5215, 860-679-8069, fortinsky@nso1.uchc.edu
Dually eligible older adults (duals) generate disproportionately high Medicare and Medicaid expenditures, yet few studies have identified risk factors for costly Medicare and Medicaid services in the same cohort of duals. Objective: Determine risk factors for Medicare hospitalization and Medicaid nursing home admission in a statewide cohort of duals living home at start of study. Methods: Subjects (n=5,232) received a uniform assessment between 7/95-6/97; all Medicare and Medicaid claims from month following assessment through 12/97 were linked. Mean length of follow up was 17 months. Dependent variables: any hospitalization (from Medicare claims); any nursing home admission (Medicaid claims). Logistic regression models were run for each dependent variable. Independent variables: age; gender; ethnicity; living arrangements; medical diagnoses; cognitive impairment (10-item SPMSQ); number of ADL and IADL dependencies, ambulation or stair climbing dependency; incontinence. Results: Subjects (79% female, age=82+8 years, 19% ethnic minority) were more likely to be hospitalized (50%) than admitted to a nursing home (30%). Major risk factors (all p<.01) for hospitalization : pneumonia (Adjusted odds ratio=2.6), heart failure (2.4), UTI (1.8), stroke (1.6), pulmonary disease (1.5). Major risk factors for nursing home admission: psychosis (1.9), severe cognitive impairment (1.9), UTI (1.7), depression (1.6), pneumonia (1.5). Functional disability measures were less important or non-significant risk factors; Blacks (0.7) and Hispanics (0.6) were less likely than Whites to experience nursing home admission. Conclusions: Many risk factors for costly Medicare and Medicaid services among duals were infectious or mental health conditions that could be prevented or alleviated with effective treatment at home.
Learning Objectives:
Keywords: Outcomes Research, Medicare/Medicaid
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.