National Study of Ocular Hospitalizations in Medicare Beneficiaries

Factors Associated with Length of Stay and Cost among Pediatric Hospitalizations with a Primary Ophthalmic Diagnosis

PURPOSE

To investigate factors associated with prolonged length of stay and high cost among pediatric hospitalizations with a primary ophthalmic diagnosis.

METHODS

This retrospective, cross-sectional study utilized data on pediatric admissions with a primary ophthalmic diagnosis from the multicenter 2016 Kids' Inpatient Database. Multivariable logistic regression models adjusted for demographic, hospital, and admission characteristics were used to evaluate factors associated with prolonged stay and high cost, defined as exceeding the 75th percentile (>4 days and $12,642, respectively).

RESULTS

An estimated 6,811 pediatric hospitalizations with a primary ophthalmic diagnosis in the United States in 2016 were included. On adjusted analysis, a prolonged length of stay was more likely with Medicaid (vs. private insurance, OR = 1.19, 95% CI: [1.02, 1.40], p = .03), non-trauma (vs. trauma, OR = 2.77, 95% CI: [2.12, 3.63], p < .001) and urban teaching hospitals (vs. rural, OR = 3.48, 95% CI: [1.04, 11.69], p = .04). A high cost of stay was more likely with higher income levels (Quartile 3 vs. 1, OR = 1.30, 95% CI: [1.02, 1.67], p = .04; Quartile 4 vs. 1, OR = 1.49, 95% CI: [1.08, 2.05], p = .02), private insurance (vs. Medicaid, OR = 1.26, 95% CI: [1.04, 1.53], p = .02), Western hospitals (vs. South, OR = 2.74, 95% CI: [1.83, 4.12], p < .001), and trauma (vs. non-trauma, OR = 3.29, 95% CI: [2.57, 4.21], p < .001). Children and young adults had higher odds of prolonged stay, while adolescents and young adults had higher odds of high cost compared to toddlers (p < .05 for all).

CONCLUSIONS

Additional work addressing the factors associated with higher resource utilization may help promote the delivery of quality inpatient pediatric eye care.

THE ASSOCIATION BETWEEN COMPLEX CATARACT SURGERY AND SOCIAL DETERMINANTS OF HEALTH IN FLORIDA

PURPOSE

To analyze differences between rates of complex and routine cataract surgery based on demographics and social determinants of health (SDOH) at the community level.

METHODS

Data from adults ages 18 to 84 relevant to cataract surgery billing codes were extracted from the 2017 Florida Ambulatory Surgery dataset from the Agency for Healthcare Research and Quality merged with SDOH measures from the American Community Survey. A multivariable logistic regression model was used to determine associations between complex cataract surgery and SDOH according to patient ZIP code. Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI).

RESULTS

A total of 171,754 and 11,340 patients received routine and complex cataract surgeries, respectively; females received the majority of routine surgeries (58.87%); most common age group (79.11%) was from 65 to 84 years. Male (odds ratio [OR] 2.034; p < 0.0001) and black patients (OR 1.998; p < 0.0001) more likely received complex surgery. Compared to Medicare patients, patients insured with Medicaid (OR 2.058; p < 0.0001), private insurance (OR 1.057; p = 0.0182), or self-pay (OR 1.570; p < 0.0001) were more likely to receive a complex surgery. ZIP codes with higher adult poverty (OR 2.614; p < 0.001) were more likely complex surgery patients, whereas those with higher rates of high school attendance (OR 0.487; p = 0.0193) and home occupancy (OR 0.704; p = 0.0047) were less likely to be complex.

CONCLUSIONS

Selected patient- and community-level factors including being male, Black, Asian, Hispanic, non-Medicare, or within lower education, higher poverty ZIP codes were associated with a higher likelihood of receiving complex cataract surgery.

Association of the Robert Wood Johnson Foundations' social determinants of health and Medicare hospitalisations for ischaemic strokes: a cross-sectional data analysis

Objective

Social determinants of health (SDH) have previously demonstrated to be important risk factors in determining health outcomes. To document whether the SDH are associated with hospitalisations for ischaemic stroke.

Methods

This cross-sectional study examines data from fiscal year 2015. Patients from the national Medicare 100% Inpatient Limited Dataset were linked with SDH measures from the Robert Wood Johnson Foundation (RWJF) County Health Rankings. Medicare patients were included in the study group if they had either an admitting or primary diagnosis of ischaemic stroke. Counties without RWJF data were excluded from the study. Ischaemic strokes were compared with all other hospitalisations associated with characteristics of the SDH measures and benchmarked to above or below their respective national median. Estimates were performed with nested logistic regression.

Results

Approximately 256 766 Medicare patients had ischaemic stroke hospitalisations compared with all other Medicare patients (n=6 386 180) without ischaemic stroke hospitalisations while 30 853 patients were excluded due to residence in US territories. Significant factors included air pollution exceeding the national median (OR 1.06; 95% CI 1.05 to 1.07), per cent of children in single parent households exceeding the national median, (OR 1.02; 95% CI 1.01 to 1.03), violent crime rates exceeding the national median, (OR 1.02; 95% CI 1.01 to 1.03) and per cent smoking exceeding the national median, (OR 1.02; 95% CI 1.01 to 1.03).

Conclusions

When cross-sectional SDH are benchmarked to national median for ischaemic stroke hospitalisations and compared with all-cause hospitalisations, the effects remain significant. Further research on the longitudinal effects of the SDH and cardiovascular health, particularly disease-specific outcomes, is needed.

Association of the Robert Wood Johnson Foundations' Social Determinants of Health and Medicare Ocular Hospitalizations: A Cross Sectional Data Analysis

INTRODUCTION

Social determinants of health (SDH) may influence inpatient utilization rates and outcomes but have yet to be associated with ocular diagnoses. The purpose of this paper was to determine whether the SDH are associated with ocular hospitalizations.

METHODS

Patients from the national Medicare 100% Inpatient Limited Dataset were examined and linked to SDH measures from the Robert Wood Johnson Foundation (RWJF) County Health Rankings. Patients were included in the study group with either an admitting or primary diagnosis of an ophthalmic condition. All other hospitalized Medicare patients served in the comparison group. Nested logistic regression of these Medicare patients was conducted in their respective communities at the county level. SDH measures were benchmarked above or below the national median.

RESULTS

Positively associated SDH factors included communities with air pollution exceeding 11.62 micro grams per cubic meter (OR 1.05; 95% CI 1.01-1.08), communities where severe housing problems exceeding 14.38% (OR 1.13; 95% CI 1.09-1.18), children in single parent households exceeding 32.13% (OR 1.06; 95% CI 1.02-1.11), violent crime rate exceeding 250.54 per 100,000 (OR 1.07; 95% CI 1.03-1.12), diabetes exceeding 10.95% (OR 1.09: 95% CI 1.04-1.14), and drug poisoning deaths including opioids exceeding 14.17 per 100,000 (OR 1.04; 95% CI 1.01-1.08).

CONCLUSION

When compared to an all-condition, hospitalized population, ocular hospitalizations tended to have small, yet statistically significant associations with health behaviors, socioeconomic, and physical environment factors. Further research will be needed on how the physical environment, social, and community variables affect ocular health relative to all-cause hospitalizations.