KYOTO — Researchers from Kyoto University and the University of California, Los Angeles, examined whether hospital admissions causally affect health outcomes and subsequent healthcare spending for persons with dementia. The study found no clear evidence that hospital admission affected 30-day or 90-day mortality for dementia patients.
Healthcare spending was approximately $2,500 higher for admitted dementia patients 30 days after an emergency room visit compared to non-admitted patients. The researchers observed similar healthcare spending increases at the 90-day mark.
The study compared outcomes for patients treated by emergency physicians with high admission tendencies against patients treated by physicians with lower admission tendencies. The researchers combined Medicare data with an instrumental variable approach that utilized the random assignment of emergency physicians to isolate causal effects.
Ryo Ikesu, a researcher, said, "A key challenge in studying the effect of hospital admission is that sicker patients are more likely to be admitted, which can make admitted patients appear to have worse outcomes even if admission itself is not the cause." The increased 30-day spending was primarily attributed to home healthcare and nursing facility care costs.
Ikesu said, "Despite evidence suggesting decline in physical and cognitive function among older people after hospital care, we did not find evidence that hospital admission was associated with this decline among long-term nursing home residents with dementia, possibly due to the small sample size." Researchers suggested evaluating home-based acute care or outpatient follow-up for dementia patients in borderline cases where hospital admission necessity is uncertain.