OBJECTIVES

: Depression is prevalent among patients with a disability and associated with increased resource utilization. Potentially avoidable hospitalizations, as described by the Center for Medicare and Medicaid Services (CMS), are inpatient stays for conditions which may not have required an inpatient stay if well managed in the outpatient setting. This study described differences in potentially avoidable hospitalizations between disabled patients with and without depression, as well as those with and without a sleep disorder.

METHODS

: Patients enrolled in a Medicare Advantage health plan and identified as disabled by CMS in 2017 were included in this descriptive, retrospective claims analysis. Depression and sleep disorders were identified using diagnosis codes in medical claims in 2016. Inpatient stays classified as potentially avoidable were identified by condition diagnosis in medical claims in 2017. Potentially avoidable hospitalizations were summarized as admissions per thousand.

RESULTS

: The mean age (standard deviation) of the cohort (N=717,916) was 62.5 (10.0) years; approximately half (51.0%) of the patients were female. Depression was observed in 17.3% of the cohort and a sleep disorder in 37.4%. Of the 260.5 hospitalizations per thousand for disabled patients in 2017, 69.4 (26.6%) were potentially avoidable. Potentially avoidable hospitalizations per thousand were higher for disabled patients with depression compared to those without depression (110.5 versus 60.8) as well as higher for disabled patients with a sleep disorder compared to those without a sleep disorder (131.6 versus 32.4).

CONCLUSIONS

: These findings highlight an opportunity to evaluate enhancements in outpatient care, which could mitigate exacerbation of conditions that could lead to an inpatient stay among disabled patients with depression or a sleep disorder. Further research is needed to evaluate potential drivers for differences in utilization.