Can Continuity of Care Reduce Hospitalization Among Community-dwelling Older Adult Veterans Living With Dementia

Bibliographic Data

ID9099004
AuthorsLianlian Lei (0000-0003-0463-2614, University of Michigan, corresponding author), Shubing Cai (0000-0002-4695-0760, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester), Yeates Conwell (0000-0001-8517-2132, Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, NY), Richard H Fortinsky (0000-0002-2013-719X, Center on Aging, University of Connecticut School of Medicine, Farmington, CT), Orna Intrator (0000-0002-4173-0662, Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester)
Year2020
Volume58
Issue11
Pages988-995
Publication date2020-11-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001386
PMID32925470
OpenAlexW3086282682
LanguageEN
Citations received1
References cited38

BACKGROUND: Hospitalization is a difficult experience, especially for patients with dementia. Understanding whether better continuity of care (COC) reduces hospitalizations can indicate interventions that might help curb hospitalizations. OBJECTIVE: To estimate the causal impact of COC on hospitalizations and different reasons for hospitalization among community-dwelling older veterans with dementia. RESEARCH DESIGN: Population-based observational study using nationwide Veterans Health Administration data linked to Medicare claims in Fiscal Years (FYs) 2014-2015. To account for unobserved confounders we used an instrumental variable for COC-whether veteran changed residence by more than 10 miles. SUBJECTS: Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (n=105,528). MEASURES: Bice-Boxerman Continuity of Care (BBC) index (0-worst to 1-best COC); binary indicators of any hospitalization for all causes, for ambulatory care sensitive conditions (ACSCs) and for reasons grouped by major diagnostic category. RESULTS: The mean BBC in FY 2014 was 0.32 (SD, 0.23). In FY 2015 43.3% of the cohort veterans were hospitalized. A 0.1 higher BBC resulted in 2.4% (95% confidence interval, 0.5%-4.4%) lower probability of hospitalization for all causes. BBC was not associated with hospitalization for ACSCs. Grouped by major diagnostic category, a 0.1 higher BBC resulted in 3.8% (95% confidence interval, 2.1%-5.4%) lower probability of hospitalization for neuropsychiatric diseases/disorders, with no impact on hospitalizations for circulatory, respiratory, infectious, kidney and urinary, digestive, musculoskeletal, and endocrine-metabolic diseases/disorders. CONCLUSIONS: Among community-dwelling older veterans with dementia, better COC resulted in less hospitalizations, and this effect was primarily due to less hospitalization for neuropsychiatric diseases/disorders but not hospitalization for ACSCs, or other hospitalization reasons

Ambulatory care · Cohort · Cohort study · Confidence interval · Confounding · Dementia · Disease · Environmental health · Health care · Odds ratio · Population · Psychiatry · Psychological intervention · Veterans Affairs · Chronic Disease Management Strategies · Frailty in Older Adults · Internal Medicine · Medicine · Primary Care and Health Outcomes · Gerontology

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