ArticleThe Journal of ambulatory care management
Diabetes, Dementia, and Disruptions in Health Care Use in 2020 for Low-Income Medicare Beneficiaries.
Article in The Journal of ambulatory care management. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDespite widespread interruptions to health care in 2020, little evidence demonstrates how populations at highest risk for poor outcomes fared across a comprehensive scope of services.
methodsAmong a predominantly low-income population of individuals ages 65 and older with diabetes (n = 4,187), we measured health care service use in Medicare and Medicaid claims data from 2018 to 2020. Stratified analyses included individuals with Alzheimer disease and related dementias (ADRD, n = 1,025), individuals who used Medicaid-funded home- and community-based services (HCBS, n = 264), and long-term nursing home services (n = 365).
resultsRelative to 2018-2019, adjusted quarterly rates of evaluation and management visits dropped by 26% (95% confidence interval [CI]: 23%-28%) in Q2 2020 and remained 7% lower (95% CI: 4%-10%) in Q4 2020. Persistent declines occurred for inpatient discharges and emergency room visits (relative risk Q4 2020 vs. 2018-2019: 0.87 [95% CI: 0.76-0.99] and 0.77 [95% CI: 0.69-0.87], respectively). Insulin fills declined in later 2020 (relative risk Q4 2020 vs. 2018-2019: 0.87 [95% CI: 0.79-0.95]) while annual wellness visits rebounded (relative risk Q4 2020 vs. 2018-2019: 1.19 [95% CI: 1.06-1.34]). Individuals who used Medicaid-funded HCBS or long-term nursing home services before the pandemic had large declines in evaluation and management visits (relative risk Q4 2020 vs. 2018-2019: 0.80 [95% CI: 0.69-0.93] and 0.63 [95% CI: 0.43-0.94], respectively). Nursing home residents also had notable declines in insulin fills (relative risk Q4 2020 vs. 2018-2019: 0.73, 95% CI: 0.55-0.96). Individuals with ADRD had increased skilled nursing facility admissions (relative ratio Q3 2020 vs. 2018-2019 1.60, 95% CI: 1.21-2.13). Telehealth usage in 2020 did not differ based on ADRD diagnosis.
conclusionsExtended disruptions in routine care highlight opportunities to improve support for older adults with diabetes.
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