Accountable Care Hospitals and Preventable Emergency Department Visits for Rural Dementia Patients
Nianyang Wang, Aitalohi Amaize, Jie Chen
Abstract
BACKGROUND/OBJECTIVES: This study examined urban/rural differences in the frequency of preventable emergency department (ED) visits among patients with Alzheimer's disease and related dementias (ADRD), with a focus on the variation of accountable care organization (ACO) participation status for hospitals in urban and rural areas. DESIGN: We performed a cross-sectional study using the 2015 State Emergency Department Databases, the American Hospital Association Annual Survey of Hospitals, and the Area Health Resource File. Individual-, county-, and hospital-level characteristics and state fixed effects were used for model specification. SETTING: Patients with ADRD from seven states who visited the ED and had routine discharges. PARTICIPANTS: Our sample consisted of 117,196 patients with ADRD. MEASUREMENTS: The outcome was preventable ED visits classified using the New York University Emergency Department visit algorithm. We performed a multivariable logistic regression to estimate the variation of preventable ED visits by urban and rural areas. RESULTS: Rural patients with ADRD had 1.13 higher adjusted odds (P = .007) of going to the ED for a preventable visit compared with their urban counterparts. In addition, ACO-affiliated hospitals had .91 lower adjusted odds (P = .005) of preventable ED visits for ADRD patients compared with hospitals not affiliated with an ACO. Whole-county Mental Health Care Health Professional Shortage Area (HPSA) (odds ratio = 1.14; P = .002) designation was also an indicator of higher preventable ED rates. CONCLUSION: ACO delivery systems have the potential to decrease rural preventable ED visits among ADRD patients.