Objectives: Examine predictors of clinical and resource utilization outcomes associated with Alzheimer's disease and related dementias (ADRD), stratified by patient severity profiles.
Methods: Cross-sectional study of adults (30+ year old) with ADRD discharged from US hospitals to home health care (HHC) and identified from the 2010-2015 Nationwide Readmissions Database (NRD) using ICD 9th-10th codes. Outcomes of interest included 30-day hospital readmissions, in-hospital mortality, and hospital length of stay (LOS). Covariates consisted of sociodemographic and clinical variables. Multiple logistic regressions (for readmissions and mortality) and generalized linear regressions (for LOS) were used to examine associations between outcomes and study covariates, stratified by patient severity profiles.
Results: Of 164,598 ADRD patients, 3,848 were mild, 68803 were moderate, 72428 were severe, and 19,519 were extreme. The 30-day readmission rate was 3.2%, death rate was 14.5%, and LOS was 3.0 days, (95%, CI: 15.0, 17.0) to 5.0 days, (95%, CI: 18.0, 19.0), all with a p-value<0.0001. Across outcomes and severity levels, the top predictors included number of diagnoses, gender, hospital bed size, primary and secondary diagnoses, and income size.
Conclusions: Severe and extreme stages of HHC discharge may lead to increased readmissions, death, LOS, and costs. Specialized care is needed to reduce these negative outcomes in the ADRD patient population.
Keywords: Alzheimer’s; Dementias; In-hospital mortality; Length of stay; Predictors; Readmissions; Utilization.