Evidence map›Paper›PMID 38838377›Full record

ArticleJournal of the American Geriatrics Society2024

Patterns of national emergency department utilization by fee-for-service Medicare beneficiaries with dementia.

Jason K Bowman, Christine S Ritchie, Kei Ouchi, James A Tulsky, Joan M Teno

Abstract read
In one paragraph

Article in Journal of the American Geriatrics Society, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Observational
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Jason K BowmanDepartment of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.ORCID https://orcid.org/0000-0003-0254-2332
Christine S RitchieHarvard Medical School, Boston, Massachusetts, USA.
Kei OuchiDepartment of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
James A TulskyDepartment of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.
Joan M TenoBrown University School of Public Health, Providence, Rhode Island, USA.

Funding

VARIATIONS IN LIFE'S FINAL CHAPTERP01AG027296 · NIA · BROWN UNIVERSITY · PI AMAL N. TRIVEDI · 2007 to 2026
$38.9M
ED GOAL: An Advance Care Planning Intervention for Seriously Ill Older Adults in the Emergency DepartmentK76AG064434 · NIA · BRIGHAM AND WOMEN'S HOSPITAL · PI OUCHI, KEI · 2020 to 2024
$1.3M
NIA NIH HHS 5P01AG027296-14/00002196NIA NIH HHS K76 AG064434NIA NIH HHS P01 AG027296
6 · The paper itself

Abstract

backgroundIndividuals with Alzheimer's disease and related dementias (ADRD) often face high acute care clinical utilization and costs with unclear benefits in survival or quality of life. The emergency department (ED) is frequently the site of pivotal decisions in these acute care episodes. This study uses national Medicare data to explore this population's ED utilization.

methodsRetrospective cohort study of persons aged ≥66 years enrolled in traditional Medicare with a Chronic Condition Warehouse diagnosis of dementia. Primary 1-year outcome measures included ED visits with and without hospitalization, ED visits per 100 days alive, and health-care costs. A multivariate random effects regression model (clustered by county of residence), adjusted for sociodemographics and comorbidities, examined how place of care on January 1, 2018, was associated with subsequent ED utilization.

resultsIn 2018, 2,680,006 ADRD traditional Medicare patients (mean age 82.9, 64.2% female, 9.4% Black, 6.2% Hispanic) experienced a total of 3,234,767 ED visits. Over half (52.2%) of the cohort experienced one ED visit, 15.5% experienced three or more, and 37.1% of ED visits resulted in hospitalization. Compared with ADRD patients residing at home without services, the marginal difference in ED visits per 100 days alive varied by location of care. Highest differences were observed for those with hospitalizations (0.48 visits per 100 days alive, 95% confidence interval [CI] 0.47-0.49), skilled nursing facility (rehab/skilled nursing facility [SNF]) stays (0.27, 95% CI 0.27-0.28), home health stays (0.25, 95% CI 0.25-0.26), or observation stays (0.82, 95% CI 0.77-0.87). Similar patterns were observed with ED use without hospitalization and health-care costs.

conclusionsPersons with ADRD frequently use the ED-particularly those with recent hospitalizations, rehab/SNF stays, or home health use-and may benefit from targeted interventions during or before the ED encounters to reduce avoidable utilization and ensure goal-concordant care.

Indexed as

DementiaEmergency Service, HospitalFee-for-Service PlansHospitalizationMedicareAgedAged, 80 and overFemaleHealth Care CostsHumansMalePatient Acceptance of Health CareRetrospective StudiesUnited StatesAlzheimer's disease and related dementiasdementiaemergency departmentpalliative care

Identifiers

PMID38838377
PMCPMC12396597

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.