Megan Brooks

July 27, 2016

TORONTO ― One in seven hospital admissions of Medicare patients with Alzheimer's disease are potentially avoidable, and preventing them could save Medicare more than $2 billion annually, according to research presented here at the Alzheimer's Association International Conference (AAIC) 2016.

Alzheimer's disease and related dementias can complicate management of diabetes and other common comorbid conditions, putting patients at risk for hospitalizations that may be preventable with proactive ambulatory care, noted presenter Pei-Jung Lin, PhD, from the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, Boston, Massachusetts.

Dr Lin and colleagues used Medicare claims data to estimate potentially avoidable hospitalization (PAH) rates for conditions treatable with ambulatory care, as well as the associated costs to Medicare, for 2,749,172 people diagnosed with Alzheimer's disease or other dementias.

They examined rates of PAH for three acute conditions (bacterial pneumonia, urinary tract infection, and dehydration) and three chronic conditions (diabetes, cardiovascular diseases, and respiratory conditions), as well as overall composite PAH rates.

In 2013, 1 in 10 (10%) people in the study had at least one PAH, and 1 in 7 (14%) hospitalizations were potentially avoidable, the researchers found.

They identified 369,165 PAHs (13,428 hospitalizations per 100,000 population) in their population, resulting in a total of $2.58 billion in Medicare expenditures. Of these, 188,870 PAHs were for acute conditions, accounting for 47% of overall PAH costs, and 180,307 were for chronic conditions, making up 53% of total PAH costs.

Patients with advanced Alzheimer's disease and related dementias were particularly vulnerable to PAH (32,027 hospitalizations for acute conditions and 25,106 hospitalizations for chronic conditions per 100,000 population). These patients accounted for 59% ($1.53 billion) of the total PAH costs.

"Our findings suggest that management of coexisting diseases remains suboptimal among many people with Alzheimer's or other dementias, especially those with advanced disease," Dr Lin said in a conference statement.

"Case management programs for people with Alzheimer's and other dementias should involve strategies to reduce avoidable hospitalizations in order to improve patient outcomes and lower costs."

Harsh Reality

In an interview with Medscape Medical News, Robert J. Egge, chief public policy officer of the Alzheimer's Association, said, "Unfortunately, this study describes reality today. This is an important codification of what we already know from talking to healthcare providers, hospitals, and families.

"Over 75% of people with Alzheimer's have coexisting conditions. Cognitive impairment keeps you from managing those other conditions that can drive you to the hospital. Sometimes it's acute conditions that get out of control, like asthma, and sometimes it's chronic conditions, like diabetes," said Egge.

"The striking thing about dementia is, we know it is the most expensive condition in the United States," and one of the drivers of cost is preventable hospitalizations. "That's what makes this a policy priority both from controlling healthcare system costs to getting better outcomes for the patients and their families," said Egge.

"We have the opportunity to change this picture with good care planning. We can save a lot of money but, more importantly, improve a lot of lives," he added.

The study was funded by an Alzheimer's Association New Investigator Research Grant. Dr Lin has disclosed no relevant financial relationships.

Alzheimer's Association International Conference (AAIC) 2016. Abstract O2-11-01. Presented July 25, 2016.

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