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Alan R Morse, Paul P Lee, William H Seiple, talwar Nidhi, Joshua D Stein; The Impact of Vision Loss on Healthcare Use by Medicare Beneficiaries Following Hospital Discharge. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5073.
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© ARVO (1962-2015); The Authors (2016-present)
To assess to what extent a diagnosis of low vision or blindness affects healthcare use following hospital discharge.
We used a national claims database of 20% of all persons with Medicare Parts A, B, and D health insurance during 2008-2014 to identify all Medicare enrollees hospitalized for 1 of the 9 most common diagnosis related groups. Each person was characterized as having no vision loss, low vision or blindness (legal blindness or worse) prior to their hospitalization based on ICD-9-CM codes. We matched 6165 eligible enrollees with low vision or blindness (cases) with 6165 eligible enrollees with no vision loss (controls) 1:1 based on age, year of hospitalization, race, sex , urban or rural residence and overall health. We compared hospital length of stay (LOS), 30-day readmission rates, 30-day Emergency Department (ED) visit rates, use of physical therapy (PT) and costs for services among these groups. Multivariable regression was used to assess the impact of vision loss on each outcome of interest.
Readmission rates were significantly higher for those with low vision (20.8%) and blindness (23.2%) compared to those with no vision loss (18.7%),(p<.02 for both). Use of ED services was significantly higher for those with low vision (21.3%) and blindness (22.4%) compared to those with no vision loss (18.7%), (p<.003 for both). Use of Physical Therapy was similar for those with low vision (5.4%, p=.10) but significantly less for those with blindness (2.2%) compared to those with no vision loss (6.2%) (p<.0001). Overall mean hospital LOS was longer for those with blindness (6.5 ± 15 days) compared to those with no vision loss (5.3 ± 7.6 days) (p<.0001) and their costs were higher ($51481 vs $50012). (p<.0002).
For Medicare beneficiaries, comorbid vision loss or blindness increases utilization of healthcare during and immediately following hospital discharge and may increases costs. These results are generally consistent with our previous work using a commercially insured population (ARVO 2016). Assessment of conditions and functional needs, i.e., patient-centric factors, could affect care and may lead to improved patient outcomes while reducing healthcare costs.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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