Patients with Alzheimer's Disease See Higher Hospital Readmission Rates

Readmission rates and episode costs were higher among patients with Alzheimer’s disease and related dementias (ADRD), suggesting hospitals should prioritize reducing avoidable hospitalizations for this population, according to a study published in JAMA Network Open.

The prevalence of ADRD is estimated to double from 1.6 percent of the population in 2014 to 3.3 percent by 2060. Past data has found that 30-day unplanned readmission rates and hospitalization costs were higher among patients with ADRD compared to the general geriatric population.

Researchers used 2012 to 2017 data from the Michigan Value Collaborative (MVC) to assess readmission rates, readmission costs, and total episode costs across different service lines and surgical procedures for patients with ADRD.

The study sample included 722,922 hospitalizations; 66,676 episodes were for patients with ADRD and 656,235 were for patients without ADRD. After propensity score matching, researchers included 58,629 hospitalizations for each group.

The mean 30-day readmission rate was 21.5 percent for patients with ADRD and 14.7 percent for patients without ADRD.

Readmission rates were higher among patients with ADRD across all 22 service lines, ranging from 11.2 percent for joint replacement to 33.2 percent for coronary artery bypass graft. Among patients without ADRD, readmission rates ranged from 5.9 percent for joint replacement to 20.3 percent for congestive heart failure.

Similarly, 30-day readmission costs were $467 higher among patients with ADRD ($8,378 versus $7,912). However, across all service lines, the difference in readmission costs varied between the two groups. For example, readmission costs for hip fractures were $766 higher for patients with ADRD, but readmission costs for acute myocardial infarction were $505 higher for patients without ADRD.

Across all service lines, the mean total 30-day episode cost of care was $2,794 higher for patients with ADRD than those without ($22,371 versus $19,578). The difference in episode payments ranged from $275 to $2,333 across all service lines.

Total episode payments include readmission and post-discharge costs, including home health, inpatient rehabilitation, and skilled nursing facility care. Post-discharge payments were significantly higher for patients with ADRD due to differences in skilled nursing facility payments, researchers noted.

Episode cost differences were more pronounced for hip and knee joint replacements, cholecystectomies, and colectomies with benign indications.

Socioeconomic factors may influence readmission rates for patients both with and without ADRD, researchers said. People in lower-income communities tend to have poorer access to primary care physicians for follow-up visits. Social determinants of health, such as transportation access and housing stability, may adversely impact access to care.

Hospitals are also responsible for readmission rates in some cases. Under the Hospital Readmissions Reduction Program (HRRP), hospitals receive penalties for having excessive readmission rates for certain conditions. However, the program does not account for the disparate outcomes among patients with ADRD, which are likely to lead to readmissions, researchers said.

“Although approximately 40% of older hospitalized patients are cognitively impaired, most hospitals are ill-equipped to minimize the risk of readmission and non–value-added healthcare spending for this increasing population,” the study stated. “Hospital discharges often come without adequate preparation for complex case management needs of patients with ADRD and their caregivers.”

Hospitals should utilize preoperative assessments to determine if patients with ADRD require inpatient procedures or if hospitalization would only exacerbate health outcomes.

Over a third of hospitalized patients with ADRD are discharged to skilled nursing facilities, and 59 percent of these patients are subsequently readmitted to the hospital. CMS implemented a program to reduce excess transfer rates to hospitals for skilled nursing facilities, but like the HRRP, it does not account for patient case mix.

“Avoidable hospitalization undermines the quality of life and longevity, possibly increasing the risk for adverse events for patients with ADRD,” researchers concluded. “Although more research is required to understand the variance across service lines in readmission risk between patients with and without ADRD, measures should be taken to ensure patient fitness for inpatient care.”