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Poorest Seniors at Risk for Repeat Hospital Stays
Spotting, offering transitional care to these patients should be priority for doctors, nurses, researcher saysMonday, December 1, 2014
MONDAY, Dec. 1, 2014 (HealthDay News) -- Seniors from the poorest U.S. neighborhoods are at increased risk for repeat trips to the hospital for heart disease or pneumonia, a new study finds.
The research, published in the Dec. 2 issue of the Annals of Internal Medicine, looked at records from nearly 256,000 Medicare patients who were discharged from a hospital after being treated for heart complications or pneumonia.
The investigators found that people were more likely to return to the hospital within a month if they lived in neighborhoods marked by poverty, low education levels and poor living conditions.
Across the "most disadvantaged" 15 percent of neighborhoods, the rate of readmission ranged from 22 percent to 27 percent. That compared with a rate of 21 percent for the remaining neighborhoods.
"We can't know from these data exactly what is going on," said lead researcher Dr. Amy Kind, of the University of Wisconsin School of Medicine and Public Health, in Madison.
All of the patients were covered by Medicare, the government health insurance program for Americans aged 65 and older. But, Kind said, people in the most disadvantaged neighborhoods may still face obstacles in getting the care they need.
These seniors may have difficulty getting prescriptions filled or eating healthy meals, for example, Kind explained. "We know that elderly adults often rely on their support networks for those things," she noted. "And that need only increases after they're discharged from the hospital."
For seniors in the poorest neighborhoods, family and friends may be unable to offer all the help that's required, according to Kind.
Her team was able to account for some other explanations, such as patients' overall health, whether they lived in a rural area and the type of hospital that treated them (private or non-profit, large or small). But neighborhood disadvantage was still linked to a small increase in the risk of being re-hospitalized.
There are no surprises in the findings, said Dr. Peter Muennig, an associate professor of health policy and management at Columbia University in New York City.
Muennig, who was not involved in the study, noted that for any one patient, many factors -- not just ZIP code -- would affect the risk of being readmitted to the hospital. The issue is whether high-risk patients can be connected with the kinds of "transitional care" they need when they're ready to leave the hospital, he said.
"And that depends on where you live," Muennig said. Larger urban hospitals can typically offer more -- like staff social workers who can help patients connect with social services, he explained.
"But in many communities, that's lacking," he added. "It's a pretty bad situation."
According to Kind, transitional care can include home visits from a nurse, for patients who have a more complex recovery plan. In other cases, a nurse can help monitor the patient's recovery through regular phone calls. Community programs -- like Meals on Wheels -- can also be helpful, she said.
"But first," Kind added, "we have to recognize which patients are in need."
According to Kind, doctors and nurses can be reluctant to ask patients about personal circumstances. But she said they can readily find out if a patient is living in a disadvantaged neighborhood, just by using their ZIP code and publicly available information.
"That can be a way to start a conversation," Kind said. "We can ask, 'Who do you live with? Are you able to get your medication? Do you have healthy food at home?' They may have a wonderful support system at home. But we need to have a conversation to find out. I'd like to see this be more at the forefront of doctors' minds."
According to the Medicare program, each year about 2.6 million beneficiaries are readmitted to the hospital within a month -- at a cost of over $26 billion. In 2011, the Affordable Care Act created the Community-based Care Transitions Program, which is testing different ways to prevent those readmissions.
That help is sorely needed, according to Muennig. "In this country, oftentimes hospital patients are simply discharged," he said. "Or they end up sitting in the hospital for an extended time. Neither is good."
SOURCES: Amy Kind, M.D., Ph.D., assistant professor, division of geriatrics, University of Wisconsin School of Medicine and Public Health, Madison; Peter Muennig, M.D., M.P.H., associate professor, health policy and management, Columbia University Mailman School of Public Health, New York City; Dec. 2, 2014,Annals of Internal Medicine
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