 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
William Buczko, PhD, ORDI/REG/DBR, Centers for Medicare & Medicaid Services, 7500 Security Blvd. C3-19-07, Baltimore, MD 21244-1850, (410) 786-6593, Wbuczko@cms.hhs.gov
This study examines Medicare hospitalizations for patients leaving a short-stay hospital against medical advice (LAMA). Prior studies of LAMA patients in the general population indicate that they are more likely to be male, not married, of lower socioeconomic status and either on Medicaid or uninsured. Findings regarding the effects of race/ethnicity are mixed but more recent studies suggest that Blacks have a higher propensity for LAMA discharges. LAMA patients often have a prior history of alcoholism or other substance abuse. There have been no prior studies of LAMA hospitalizations in the Medicare population. Patients with LAMA discharges have been found have more complex treatment histories (more comorbidities, prior LAMA discharges, higher readmission rates) than other comparable patients. Some studies indicate that while LAMA patients have shorter lengths of stay and lower costs during their index hospitalization, overall treatment periods and total treatment costs are higher for these patients. Thus, these patients present a greater challenge for disease management efforts not only for alcohol/substance dependency but also for respiratory diseases, cardiovascular diseases and diabetes. This study examines MEDPAR inpatient hospital discharge data for Medicare fee-for-service beneficiaries for fiscal years 1990-1999 for all hospital stays where the discharge status indicates LAMA. These hospitalizations are compared to data for all Medicare hospital stays for these years. Length of stay and other resource use are examined by patient age, race, sex, Medicaid eligibility, presence of alcohol related comorbidities and condition prompting hospitalization. LAMA discharges represented from 0.52% to 0.6% of Medicare discharges in the period from 1990 to 1999. LAMA patients are disproportionately male and nonwhite. Over 50% of LAMA patients were disabled Medicare beneficiaries under age 65 compared to nearly 15% of all Medicare hospital patients. Over 20 percent of all Medicare LAMA discharges were for either DRG 433 (Alcohol/Drug Abuse or Dependence, Left AMA) or DRG 430 (Psychoses). Approximately 25% of LAMA discharges were for cardiovascular conditions and 7% were for treatment of respiratory conditions. Stay lengths are shorter and resource use is markedly lower for LAMA patients indicating that they likely have not completed their full course of treatment.Incomplete treatment for LAMA patients may be reflected in inpatient readmission, greater use of outpatient services or higher post-discharge mortality rates compared to Medicare beneficiaries completing their treatment.
Learning Objectives:
Keywords: Medicare, Hospitals
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employed as a Research Analyst by CMS.