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APHA Scientific Session and Event Listing

Stephanie L. Maxwell, PhD and Timothy Waidmann, PhD. Health Policy Center, The Urban Institute, 2100 M Street, NW, Washington, DC 20037, 202-261-5825, smaxwell@ui.urban.org

Congestive heart failure (CHF) is the leading diagnosis of Medicare hospitalizations, fourth leading cause for Medicare skilled nursing facility admissions, and a common diagnosis among nursing home residents. AHRQ estimates that about 795,000 elderly with CHF had preventable hospitalizations in 1999, making CHF an important target for disease management programs. This study analyzed patterns of hospital, nursing home, and ambulatory encounters and spending among a national cohort (n=347,582) of elderly first hospitalized for CHF in 1999. Medicare enrollment and claims data were used to identify patterns of service use, spending, and Medicaid enrollment over three years. Nursing home patient assessments identified nursing home entry. Hazard models were used to estimate risks of re-hospitalization, nursing home admission, Medicaid spenddown and death. Over 3 years, 35% of the cohort was rehospitalized for CHF, 11% entered a long-term nursing facility, and 56% died. 8% enrolled in Medicaid. After controlling for comorbidities, sex, race, and age we find substantial variability across states in utilization and expenditures as well as in the risks of rehospitalization, nursing home admission, and death. The increasing longevity of the U.S. population and the movement of the “Baby Boom” generation into older ages-where risks and expenditures for chronic disease, functional decline, and long-term care use are high-add urgency to the need for more information about the elderly with chronic disease and their risk for long-term care use. This study provides a national baseline of the patterns of medical and nursing home service use among the elderly with CHF.

Learning Objectives: At the conclusion of this presentation, the learner will be able to

• Articulate the burden of congestive heart failure (CHF) on the elderly, in terms of its prevalence, mortality, and hospitalization rates.
• Describe the typical medical and long-term care trajectory of elderly once they have been first hospitalized with CHF, in terms of type of care used and spend-down to Medicaid.
• Identify key factors associated with variation in rates of death, hospitalization, nursing home entry, and Medicaid spenddown among the elderly with CHF.

Keywords: Elderly, Medicare/Medicaid

Presenting author's disclosure statement:

Not Answered

Handout (.ppt format, 121.5 kb)