Successful Discharge to Community Gap of FFS Medicare Beneficiaries With and Without ADRD Narrowed.
BACKGROUND/OBJECTIVES
We sought to compare the post-acute and long-term care experience of Medicare beneficiaries with and without Alzheimer Disease and Related Dementias (ADRD), and whether differences changed from January 1, 2007 to September 30, 2015.


DESIGN
Retrospective cross-sectional trend study using Medicare claims linked to the Centers for Medicare & Medicaid Services' (CMS) Minimum Data Set.


SETTING
CMS-certified skilled nursing facilities (skilled nursing facility (SNF), n = 17,043).


PARTICIPANTS
Fee-for-service Medicare beneficiaries aged ≥66 years (n = 6,614,939) discharged from a hospital to a SNF who had not lived in a nursing home during the year before hospitalization.


MEASUREMENTS
ADRD was defined by the Chronic Condition Data Warehouse. Outcome measures included: (1) successful discharge defined as being in SNF less than 90 days, then discharged back to the community, alive without subsequent inpatient health care for 30 continuous days; (2) became long-stay resident in SNF; (3) death in SNF within 90 days; (4) hospital readmission within 30 days of entering SNF; and (5) transferred to another nursing home within 30 days of entering SNF.


RESULTS
Successful discharge of beneficiaries with ADRD increased from 43.4% in 2007 to 53.9% in 2015 (average annual percent change (AAPC) = 2.1 (95% CI = 2.0-2.2)); those without ADRD also increased (from 59.1% to 63.6%, AAPC = 0.9 (95% CI = 0.7-1.1)) but not as fast as those with ADRD (P < .01). The proportion of all beneficiaries who became long-stay or were readmitted to the hospital decreased (P < .05). The proportion with ADRD who became long-stay was nearly three times higher than those without throughout the study (15.0% vs 5.5% in 2007; 11.3% vs 4.3% in 2015).


CONCLUSION
Though disparity in ADRD in becoming long-stay residents remains, the increase in successful discharges among those with ADRD also stresses the increasing importance of community as a care setting for adults with ADRD.
['Bardenheier|Barbara H|BH|', 'Rahman|Momotazur|M|0000-0002-8592-3511', 'Kosar|Cyrus|C|', 'Werner|Rachel M|RM|', 'Mor|Vincent|V|']
D000359:Aftercare D000368:Aged D000544:Alzheimer Disease D003430:Cross-Sectional Studies D005260:Female D006760:Hospitalization D006801:Humans D007902:Length of Stay D008297:Male D006278:Medicare D010351:Patient Discharge D010359:Patient Readmission D012866:Skilled Nursing Facilities D016896:Treatment Outcome D014481:United States
successful discharge ADRD disparity