Predictors of 30-day readmission, mortality, and length of stay for hospitalized U.S. patients with Alzheimer’s and related dementias from 2010 to 2015

ABSTRACT

Objectives

Examine predictors of clinical and resource utilization outcomes associated with Alzheimer’s disease and related dementias (ADRD), stratified by patient severity profiles.

Methods

Cross-sectional study of adults (30+ year old) with ADRD discharged from US hospitals to home health care (HHC) and identified from the 2010–2015 Nationwide Readmissions Database (NRD) using ICD 9^th-10^th codes. Outcomes of interest included 30-day hospital readmissions, in-hospital mortality, and hospital length of stay (LOS). Covariates consisted of sociodemographic and clinical variables. Multiple logistic regressions (for readmissions and mortality) and generalized linear regressions (for LOS) were used to examine associations between outcomes and study covariates, stratified by patient severity profiles.

Results

Of 164,598 ADRD patients, 3,848 were mild, 68803 were moderate, 72428 were severe, and 19,519 were extreme. The 30-day readmission rate was 3.2%, death rate was 14.5%, and LOS was 3.0 days, (95%, CI: 15.0, 17.0) to 5.0 days, (95%, CI: 18.0, 19.0), all with a p-value<0.0001. Across outcomes and severity levels, the top predictors included number of diagnoses, gender, hospital bed size, primary and secondary diagnoses, and income size.

Conclusions

Severe and extreme stages of HHC discharge may lead to increased readmissions, death, LOS, and costs. Specialized care is needed to reduce these negative outcomes in the ADRD patient population.

KEYWORDS:

• Alzheimer’s
• Dementias
• In-hospital mortality
• Length of stay
• Predictors
• Readmissions
• Utilization

Article highlights

• Few US studies exist that account for patient severity profiles when examining association between clinical and resource utilization of patients with ADRD and predictors.

• The study found that higher severity categories (severe and extreme) were linked to higher rates of 30-day readmissions, in-hospital death, and longer hospital stays.

• Adults discharged to HHC during severe and extreme stages of ADRD require greater attention and specialized care to avoid negative outcomes like early readmissions, death, and prolonged LOS.

Acknowledgments

The authors would like to thank the University of Florida, Department of Pharmaceutical Outcomes and Policy for hosting the research and providing an IRB for this study. We are grateful to Arinze Nkemdirim Okere, PharmD, for reviewing our manuscript.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

One peer reviewer declares: acknowledgment of work with companies developing diagnostics and treatments for Alzheimer’s disease. One peer reviewer declares: consultant for Alzheimer’s disease company TauRx. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Data availability statement

Additional data will be made available upon reasonable request.

Author contributions

Conceptualization: V Sanogo, V Diaby, Z Chen, R Almutairi, H Xiao; Writing – original draft preparation: V Sanogo, V Diaby, R Almutairi, Z Chen; Writing – review and editing: V Diaby, R Almutairi, V Sanogo; Supervision: V Diaby and H Xiao; All authors read and approved the final manuscript for publication.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14737167.2023.2195628

Additional information

Funding

This paper was not funded.