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Association of Vision Loss With Hospital Use and Costs Among Older Adults

Educational Objective
To assess whether the mean hospitalization lengths of stay, readmission rates, and costs of hospitalization differed between individuals with vision loss and those without when they are hospitalized for similar medical conditions.
1 Credit CME
Key Points

Question  Do hospitalized patients with vision loss experience greater resource use and costs compared with hospitalized patients without vision loss?

Findings  In this study of 12 330 Medicare beneficiaries and 11 858 commercial health insurance enrollees with or without vision loss, severe vision loss was associated with longer mean length of stay, higher readmission rates, and higher costs during hospitalization and 90 days after discharge.

Meaning  These results suggest that, by addressing vision-related issues, opportunities exist to reduce lengths of stay, readmission rates, resource use, and costs while enhancing outcomes and patient satisfaction.

Abstract

Importance  Patients with vision loss who are hospitalized for common illnesses are often not identified as requiring special attention. This perception, however, may affect the outcomes, resource use, and costs for these individuals.

Objective  To assess whether the mean hospitalization lengths of stay, readmission rates, and costs of hospitalization differed between individuals with vision loss and those without when they are hospitalized for similar medical conditions.

Design, Setting, and Participants  This analysis of health care claims data used 2 sources: Medicare database and Clinformatics DataMart. Individuals with vision loss were matched 1:1 to those with no vision loss (NVL), on the basis of age, years from initial hospitalization, sex, race/ethnicity, urbanicity of residence, and overall health. Both groups had the same health insurance (Medicare or a commercial health plan), and all had been hospitalized for common illnesses. Vision loss was categorized as either partial vision loss (PVL) or severe vision loss (SVL). Data were analyzed from April 2015 through April 2018.

Main Outcomes and Measures  The outcomes were lengths of stay, readmission rates, and health care costs during hospitalization and 90 days after discharge. Multivariable logistic and linear regression models were built to identify factors associated with these outcomes among the NVL, PVL, and SVL groups.

Results  Among Medicare beneficiaries, 6165 individuals with NVL (with a mean [SD] age of 82.0 [8.3] years, and 3833 [62.2%] of whom were female) were matched to 6165 with vision loss. Of those with vision loss, 3401 (55.2%) had PVL and 2764 (44.8%) had SVL. In the Clinformatics DataMart database, 5929 individuals with NVL (with a mean [SD] age of 73.7 [15.1] years, and 3587 [60.5%] of whom were female) were matched to 5929 individuals with vision loss. Of the commercially insured enrollees with vision loss, 3515 (59.3%) had PVL and 2414 (40.7%) had SVL. Medicare enrollees with SVL, compared with those with NVL, had longer mean lengths of stay (6.48 vs 5.26 days), higher readmission rates (23.1% vs 18.7%), and higher hospitalization and 90-day postdischarge costs ($64 711 vs $61 060). Compared with those with NVL, Medicare beneficiaries with SVL had 4% longer length of stay (estimated ratio, 1.04; 95% CI, 1.01-1.07; P = .02), 22% higher odds of readmission (odds ratio, 1.22; 95% CI, 1.06-1.41; P = .007), and 12% higher costs (estimated cost ratio, 1.12; 95% CI, 1.06-1.18; P < .001). Similar findings were obtained for those with commercial health insurance. When these findings were extrapolated to hospitalizations of patients with vision loss nationwide, an estimated amount of more than $500 million in additional costs annually were spent caring for these patients.

Conclusions and Relevance  These findings suggest that opportunities for improving outcomes and reducing costs exist in addressing patients’ vision loss and concomitant functional difficulties during hospitalization and thereafter.

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Article Information

Accepted for Publication: January 31, 2019.

Corresponding Author: Alan R. Morse, JD, PhD, Lighthouse Guild, 250 W 64th St, New York, NY 10023 (armorse@lighthouseguild.org).

Published Online: April 4, 2019. doi:10.1001/jamaophthalmol.2019.0446

Author Contributions: Dr Stein had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Morse, Stein.

Acquisition, analysis, or interpretation of data: Seiple, Talwar, Lee, Stein.

Drafting of the manuscript: Morse, Seiple, Stein.

Critical revision of the manuscript for important intellectual content: Morse, Seiple, Talwar, Lee.

Statistical analysis: Seiple, Talwar.

Supervision: Morse.

Conflict of Interest Disclosures: Dr Morse reported grants from Linder Fund outside of the submitted work. Dr Stein reported grants from the National Eye Institute, Lighthouse Guild, and Research to Prevent Blindness during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported by Linder Fund (Dr Morse), W. K. Kellogg Foundation (Drs Lee and Stein), Research to Prevent Blindness (Dr Stein), Department of Veterans Affairs RR&D (Dr Seiple), and grant R01EY026641 from the National Institutes of Health (Dr Stein).

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Meeting Presentations: Portions of this paper were presented at the Association for Research in Vision and Ophthalmology meetings, May 4, 2016, Seattle, Washington, and May 10, 2017, Baltimore, Maryland.

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