Dataset Information

Depression and risk of hospitalizations for ambulatory care-sensitive conditions in patients with diabetes.

ABSTRACT:

Background

Hospitalizations for ambulatory care-sensitive conditions (ACSCs), conditions that should not require inpatient treatment if timely and appropriate ambulatory care is provided, may be an important contributor to rising healthcare costs and public health burden.

Objective

To examine if probable major depression is independently associated with hospitalization for an ACSC in patients with diabetes.

Design

Secondary analysis of data from a prospective cohort study.

Participants

Population-based cohort of 4,128 patients with diabetes ? 18 years old seen in primary care, who were enrolled between 2000 and 2002 and followed for 5 years (through 2007).

Main measures

Depressive symptoms were assessed with the Patient Health Questionnaire-9. Outcomes of interest included time to initial hospitalization for an ACSC and total number of ACSC-related hospitalizations. We used Cox proportional hazards regression models to ascertain an association between probable major depression and time to ACSC-related hospitalization, as well as Poisson regression for models examining probable major depression and number of ACSC-related hospitalizations.

Key results

Patients' mean age at study enrollment was 63.4 years (Standard Deviation: 13.4 years). Over the 5-year follow-up period, 981 patients in the study were hospitalized a total of 1,721 times for an ACSC, comprising 45.1 % of all hospitalizations. After adjusting for baseline demographic, clinical and health-risk behavioral factors, probable major depression was associated with initial ACSC-related hospitalization (Hazard Ratio: 1.41, 95 % Confidence Interval [95 % CI]: 1.15, 1.72) and number of ACSC-related hospitalizations (Relative Risk: 1.37, 95 % CI: 1.12, 1.68).

Conclusions

Probable major depression in patients with diabetes is independently associated with hospitalization for an ACSC. Additional research is warranted to ascertain if effective interventions for depression in patients with diabetes could reduce the risk of hospitalizations for ACSCs and their associated adverse outcomes.

SUBMITTER: Davydow DS

PROVIDER: S-EPMC3682035 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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Publications

Depression and risk of hospitalizations for ambulatory care-sensitive conditions in patients with diabetes.

Davydow Dimitry S DS Katon Wayne J WJ Lin Elizabeth H B EH Ciechanowski Paul P Ludman Evette E Oliver Malia M Von Korff Michael M

Journal of general internal medicine 20130117 7

<h4>Background</h4>Hospitalizations for ambulatory care-sensitive conditions (ACSCs), conditions that should not require inpatient treatment if timely and appropriate ambulatory care is provided, may be an important contributor to rising healthcare costs and public health burden.<h4>Objective</h4>To examine if probable major depression is independently associated with hospitalization for an ACSC in patients with diabetes.<h4>Design</h4>Secondary analysis of data from a prospective cohort study.< ...[more]

PMID: 23325384

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Project description:ImportanceThe association of the COVID-19 pandemic with the quality of ambulatory care is unknown. Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are a well-studied measure of the quality of ambulatory care; however, they may also be associated with other patient-level and system-level factors.ObjectiveTo describe trends in hospital admissions for ACSCs in the prepandemic period (March 2019 to February 2020) compared with the pandemic period (March 2020 to February 2021).Design, setting, and participantsThis cross-sectional study of adults enrolled in a commercial health maintenance organization in Michigan included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period.ExposureCOVID-19 pandemic (March 2020 to February 2021).Main outcomes and measuresAdjusted relative risk (aRR) of ACSC hospitalizations and intensive care unit stays for ACSC hospitalizations and adjusted incidence rate ratio of the length of stay of ACSC hospitalizations in the prepandemic (March 2019 to February 2020) vs pandemic (March 2020 to February 2021) periods, adjusted for patient age, sex, calendar month of admission, and county of residence.ResultsThe study population included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period, in which 51.3% of person-months (n = 6 547 231) were for female patients, with a relatively even age distribution between the ages of 24 and 64 years. The relative risk of having any ACSC hospitalization in the pandemic period compared with the prepandemic period was 0.72 (95% CI, 0.69-0.76; P < .001). This decrease in risk was slightly larger in magnitude than the overall reduction in non-ACSC, non-COVID-19 hospitalization rates (aRR, 0.82; 95% CI, 0.81-0.83; P < .001). Large reductions were found in the relative risk of respiratory-related ACSC hospitalizations (aRR, 0.54; 95% CI, 0.50-0.58; P < .001), with non-statistically significant reductions in diabetes-related ACSCs (aRR, 0.91; 95% CI, 0.83-1.00; P = .05) and a statistically significant reduction in all other ACSC hospitalizations (aRR, 0.79; 95% CI, 0.74-0.85; P < .001). Among ACSC hospitalizations, no change was found in the percentage that included an intensive care unit stay (aRR, 0.99; 95% CI, 0.94-1.04; P = .64), and no change was found in the length of stay (adjusted incidence rate ratio, 1.02; 95% CI, 0.98-1.06; P = .33).Conclusions and relevanceIn this cross-sectional study of adults enrolled in a large commercial health maintenance organization plan, the COVID-19 pandemic was associated with reductions in both non-ACSC and ACSC hospitalizations, with particularly large reductions seen in respiratory-related ACSCs. These reductions were likely due to many patient-level and health system-level factors associated with hospitalization rates. Further research into the causes and long-term outcomes associated with these reductions in ACSC admissions is needed to understand how the pandemic has affected the delivery of ambulatory and hospital care in the US.

Project description:BACKGROUND:The teach-back method, also known as the "show-me" method, has been endorsed by many medical and health care societies. However, limited investigation has been conducted regarding its association with patient outcomes. OBJECTIVES:To examine the association between patient teach-back experience and the risk of hospitalizations and length of hospital stay among patients with ambulatory care sensitive conditions (ACSCs). DESIGN:A matched cohort study. SETTING:Data from the 2011-2015 Longitudinal Medical Expenditure Panel Survey (panels 16-19). PARTICIPANTS:Three thousand nine hundred ninety-four US adults aged ??18 years with any of 5 ACSCs (hypertension, type 2 diabetes, heart disease, asthma, and chronic obstructive pulmonary disease [COPD]). MEASUREMENTS:Hospital admissions (all-cause or ACSC-related) and the length of stay of the first admission were examined by teach-back during interaction with a health provider. RESULTS:Patients with teach-back experience were less likely to experience hospitalization for an ACSC-related condition (relative risk, 0.85; 95% CI, 0.71 to 0.99) and had a lower risk for a condition-related readmission (hazard ratio, 0.77; 95% CI, 0.60 to 0.99), compared with those without teach-back experience. The median length of hospital stay did not differ between patients with teach-back experience and those without teach-back experience (median 3 days [IQR 1 to 8 days] and median 3 days [IQR 0 to 8 days], respectively; P?= 0.84). Subgroup analysis showed that the association of reported teach-back experience on the outcomes was relatively stable among those with hypertension, diabetes, and heart disease, but was not among those with asthma or COPD. LIMITATION:Teach-back exposure relied on patient self-reported information. CONCLUSIONS:Our findings suggest that patient teach-back method is associated with reduced risk of hospitalization for those with ACSCs, especially among patients with cardiovascular diseases and type 2 diabetes. Encouraging providers to utilize the teach-back method at every visit has the potential to further reduce hospitalizations for individuals with ACSCs.

Dataset Information

Depression and risk of hospitalizations for ambulatory care-sensitive conditions in patients with diabetes.

Background

Objective

Design

Participants

Main measures

Key results

Conclusions

Publications

Depression and risk of hospitalizations for ambulatory care-sensitive conditions in patients with diabetes.

Similar Datasets

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