Medical care utilization among older HMO members with and without hypertension

Hypertension, diabetes, hypercholesterolemia, and their combinations increased health care utilization and decreased health status

BACKGROUND AND OBJECTIVE

For individuals with hypertension, diabetes, or hypercholesterolemia, the relative magnitude of cardiovascular risk factors and the effect of multiple risk factors remains controversial and both treatment practices and health care usage vary. We sought to determine the effect of hypertension, diabetes, hypercholesterolemia, and their combinations on health care utilization and health status through analysis of data from a large national survey.

METHODS

We applied the Anderson model to a cross-sectional representative sample (n=15,107) of the U.S. civilian, noninstitutionalized population (the 1996 Medical Expenditure Panel Survey).

RESULTS

For diabetes, additional risk factors did not increase the likelihood of emergency room (ER) visits or hospitalizations but were associated with increased outpatient visits and poorer health status. For hypertension, additional risk factors increased the likelihood of hospitalization (but not ER visits), the number of outpatient visits, and poorer health status. For hypercholesterolemia, additional risk factors were associated with increased likelihood of ER visits, hospitalizations, and poorer health status but not more outpatient visits. Diabetes had the largest effect on health care utilization and health status.

CONCLUSION

These findings re-emphasize the magnitude of diabetes as a major risk factor associated with increased ER visits, hospitalizations, outpatients visits, and lower health status.

Association between antihypertensive agent use and hospital admissions in a managed care population

BACKGROUND

Utilization of medical care services has been used as a surrogate for outcome of patient compliance with treatment regimens. Antihypertensive treatment status and selection of drug agents may influence medical utilization. The purpose of this study was to determine the association between medically untreated hypertension and treated hypertension according to class of antihypertensive agent with the rate of hospitalization.

METHODS

This is a retrospective, observational study on adult hypertensive patients based on claim data from a network-model HMO. The 12,548 patients were identified by ICD-9-CM hypertensive codes over a 3-year period. The hospital admission rate was the outcome measurement. The exploratory variables included antihypertensive treatment status and drug class. Patients' age, gender, and coexisting medical conditions were treated as confounding factors. Descriptive analyses and multivariate regression analyses were performed.

RESULTS

Coexisting medical conditions were significant factors in hospital admission rates. Compared with diuretic treatment, there were no differences in hospital admission rates among hypertensive patients treated with an angiotensin II antagonist or angiotensin-converting enzyme inhibitor. Untreated patients or those treated with beta-blockers or calcium channel blockers experienced higher hospitalization rates (95% CI, 1.25-1.90, 1.03-1.44, and 1.08-1.46, respectively).

CONCLUSIONS

Compared with the major antihypertensive agents or no therapy for hypertension, diuretic or angiotensin-converting enzyme inhibitor therapy may result in a reduced rate of hospital utilization.

A comparison of two methods for identifying frail Medicare-aged persons

This article compares the efficacy of two screening methods to identify frail Medicare-aged persons using self-report questionnaire data: a clinical judgment method developed by nurse and social worker professionals in a community-based long-term care department and an empirical research method previously developed by the Center for Health Research using computer formulas and stepwise logistic regression coefficients. A sub-aim was to see whether the empirical method proved robust over time by measuring aggregate utilization and mortality in frail and nonfrail cohorts, which would increase the interest of physicians, managed care organizations, and other agencies providing service to Medicare beneficiaries.

Repeated hospitalizations and self-rated health among the elderly: a multivariate failure time analysis

The purpose of this study was to determine to what extent a single measure, self-rated health (SRH), independently predicts long-term hospitalizations due to all causes and to cardiovascular diseases by using both the standard Cox proportional hazards model and a more robust events model. The study cohort consisted of 2,812 elderly subjects residing in New Haven, Connecticut, who were followed from 1982 to 1996 as part of the Established Populations for Epidemiologic Study of the Elderly. After adjustment for baseline risk factors, using the Cox model, a favorable SRH was associated with a significantly lowered risk for a first hospitalization for all causes (risk ratio (RR) = 0.850, 95% confidence interval (CI): 0.774, 0.934) and congestive heart failure (RR = 0.599, 95% CI: 0.426, 0.841) but not for myocardial infarction (RR = 0.882, 95% CI: 0.565, 1.379). With the adjusted robust events model, a positive SRH was associated with a decreased risk in both a first (RR = 0.813, 95% CI: 0.744, 0.889) and a second (RR = 0.870, 95% CI: 0.782, 0.968) hospitalization for any cause. These results indicate that a single measurement of SRH predicts long-term patterns of hospitalization, especially for heart failure, among older adults.

[Risk factors for hospital admission in persons older than 64-years of age]

OBJECTIVE

To determine factors associated with hospitalization in a representative sample of population older than 64 years.

DESIGN AND PARTICIPANTS

Cohort study on a sample of 3,214 representative subjects of the population 65 years and older from the judicial district of Toledo (Spain).

METHOD

Personal home interview collecting data on: sociodemographic factors, comorbidity, basic and instrumental activities of daily life, conigitive decline and depressive disorder, self-rated health and previous use of health services. Hospital discharge in the 12-month period after the interview in anyone of the three hospitals in the study area were analyzed.

RESULTS

342 (10.6%) of the subjects spent at least one night in the hospital in the year after the accomplishment of the interview. Risk factors for hospitalization in the logistical model were: advanced age (OR: 1.02), male sex (OR: 1.37), presence of cardiopathy (OR: 1.97) or chronic obstruction to airflow (OR: 1.57), visual deficit (OR: 1.88), worse self-rated health (OR: 1.37) and having used the hospital previously (OR: 3.45). Alcohol consumption was a protective factor (OR: 0.70).

CONCLUSIONS

Risk factors for hospitalization are of diverse origin. The previous admission is the strongest predictive factor for new hospitalization.