Dataset Information

Disproportionate Use of Inpatient Care by Older Adults With Kidney Stones.

ABSTRACT: OBJECTIVE:To describe variation in utilization and costs of inpatient care for patients with kidney stones, examining associations with older age. MATERIALS AND METHODS:Using the Nationwide Inpatient Sample we examined inpatient discharges with stone diagnoses from 2007 to 2011. We examined length of stay, hospitalization cost, and postdischarge care utilization using multivariable regression to identify associations between patient/hospital characteristics and resource. RESULTS:An estimated 1.7 million hospital discharges for stone disease occurred during the study period. Median length of stay was 2.1 days with a median cost of $6300. Hospital use was substantially higher among persons ?65 years old (older adults) as compared to those aged 18-64 (younger adults): median length of stay was 3.1 days, with 25% staying more than 5.9 days. Older adults were significantly more likely to utilize home health (odds ratio [OR] 3.6) or skilled nursing (OR 5.0) after discharge. Older adults accounted for 1 in 3 hospital discharges, 40% of costs, and half of postdischarge care utilization. They were more likely to be septic during hospitalization (OR 1.8) which doubled costs per episode, but less likely to receive surgery (OR 0.93). CONCLUSION:While historically at lower risk for kidney stones compared to younger adults, older adults utilizing inpatient care account for a disproportionate share of the economic burden of disease. Utilization is higher for older adults across multiple dimensions, including hospital costs, length of stay, and postdischarge care. These findings suggest that efforts to understand and mitigate the impact of kidney stones on this vulnerable population are required.

SUBMITTER: Cone EB

PROVIDER: S-EPMC6689223 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Disproportionate Use of Inpatient Care by Older Adults With Kidney Stones.

Cone Eugene B EB Hammill Bradley G BG Routh Jonathan C JC Lipkin Michael E ME Preminger Glenn M GM Schmader Kenneth E KE Scales Charles D CD

Urology 20180623

<h4>Objective</h4>To describe variation in utilization and costs of inpatient care for patients with kidney stones, examining associations with older age.<h4>Materials and methods</h4>Using the Nationwide Inpatient Sample we examined inpatient discharges with stone diagnoses from 2007 to 2011. We examined length of stay, hospitalization cost, and postdischarge care utilization using multivariable regression to identify associations between patient/hospital characteristics and resource.<h4>Result ...[more]

PMID: 29940233

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Project description:BackgroundNationally, there is a sharp increase in older adults with opioid use disorder (OUD). However, we know little of the acute healthcare utilization patterns and medical comorbidities among this population.ObjectiveThis study describes the prevalence of chronic conditions, patterns of inpatient utilization, and correlates of high inpatient utilization among older adults with OUD in New York City (NYC).DesignRetrospective longitudinal cohort study.ParticipantsPatients aged ≥55 with OUD hospitalized in NYC in 2012 identified using data from New York State's Statewide Planning and Research Cooperative System (SPARCS).Main measuresThe prevalence of comorbid substance use diagnoses, chronic medical disease, and mental illness was measured using admission diagnoses from the index hospitalization. We calculated the ICD-Coded Multimorbidity-Weighted Index (MWI-ICD) for each patient to measure multimorbidity. We followed the cohort through September 30, 2015 and the outcome was the number of rehospitalizations for inpatient services in NYC. We compared patient-level factors between patients with the highest use of inpatient services (≥7 rehospitalizations) during the study period to low utilizers. We used multiple logistic regression to examine possible correlates of high inpatient utilization.Key resultsOf 3669 adults aged ≥55 with OUD with a hospitalization in 2012, 76.4% (n=2803) had a subsequent hospitalization and accounted for a total of 22,801 rehospitalizations during the study period. A total of 24.7% of the cohort (n=906) were considered high utilizers and had a higher prevalence of alcohol and cocaine-related diagnoses, congestive heart failure, diabetes, schizophrenia, and chronic obstructive pulmonary disease. Multivariable predictors of high utilization included being a Medicaid beneficiary (adjusted odds ratio [aOR]=1.70, 95% confidence interval [CI]=1.37-2.11), alcohol-related diagnoses (aOR=1.43, 95% CI: 1.21-1.69), and increasing comorbidity measured by MWI-ICD (highest MWI-ICD quartile: aOR=1.98, 95% CI=1.59-2.48).ConclusionsAmong older adults with OUD admitted to the hospital, multimorbidity is strongly associated with high inpatient utilization.

Project description:RationaleAlthough observational and experimental studies have shown that volunteering is linked with better mental health, physical health, and health behaviors, no studies have examined whether volunteering is associated with patterns of health care use.ObjectiveThe purpose of this study was to prospectively examine whether volunteering was associated with a greater use of preventive health care services, but fewer doctor visits and nights spent in the hospital.MethodsParticipants (n = 7168) were drawn from the 2006 wave of the Health and Retirement Study, a nationally representative panel study of American adults over the age of 51, and tracked for one wave (2 years). Logistic regression and generalized linear models were used for analyses.ResultsIn analyses that adjusted for sociodemographic factors and baseline health, volunteers were 30% more likely to receive flu shots (OR = 1.30, 95% CI = 1.16-1.47), 47% more likely to receive cholesterol tests (OR = 1.47, 95% CI = 1.24-1.74); female volunteers were 53% more likely to receive mammograms/x-rays (OR = 1.53, 95% CI = 1.28-1.83) and 21% more likely to receive Pap smears (OR = 1.21, 95% CI = 1.03-1.41); male volunteers were 59% more likely to receive prostate exams (OR = 1.59, 95% CI = 1.29-1.95). In a model that adjusted for sociodemographic factors, volunteers spent 38% fewer nights in the hospital (RR = 0.62, 95% CI = 0.52-0.76), however volunteering was not associated with frequency of doctor visits (RR = 0.94, 95% CI = 0.87-1.02). The association between volunteering and number of nights spent in the hospital was minimally affected after adjusting for potential confounding (baseline health) and explanatory variables (health behaviors, social integration, stress, positive psychological factors, personality).ConclusionThis is the first known study to examine the association between volunteering and health care use. If future studies replicate these findings, the results may be used to inform the development of new strategies for increasing preventive health screenings, lowering health care use and costs, and enhancing the health of older adults.

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Disproportionate Use of Inpatient Care by Older Adults With Kidney Stones.

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Disproportionate Use of Inpatient Care by Older Adults With Kidney Stones.

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