Neurology · Internal Medicine · Public Health · 2 h ago
Hospital Discharge Patterns Explain Much of the Racial Gap in Specialized Dementia Care
This retrospective cohort study analyzed Medicare claims for 1,428,849 beneficiaries with dementia hospitalized between 2018 and 2019. Black and Hispanic patients were less likely than White patients to enter nursing homes with Alzheimer special care units, with much of the difference linked to the hospitals where patients received care.
- Hospital clustering narrowed observed racial and ethnic differences.
- Black patients remained less likely to enter an ASCU after adjustment.
- Hospital discharge patterns accounted for much of the disparity.
Researchers used 100% Medicare fee-for-service claims to examine whether race and ethnicity were associated with admission to a nursing home Alzheimer disease special care unit (ASCU) after hospitalization. The retrospective cohort included 1,428,849 beneficiaries with a prior dementia diagnosis; 122,654 became long-term care residents within six months of discharge, and 19,313 entered facilities with an ASCU.
In unadjusted analyses, the relative probability of ASCU admission, compared with White patients, was 0.69 for Black patients (95% CI, 0.65–0.73) and 0.48 for Hispanic patients (95% CI, 0.44–0.53). Accounting for patient clustering within hospitals narrowed the differences to 0.94 and 0.78, respectively. After adjustment for patient and hospital characteristics, the relative probabilities were 0.89 (95% CI, 0.84–0.95) for Black patients and 0.93 (95% CI, 0.84–1.02) for Hispanic patients. Among beneficiaries who entered long-term care, a disparity remained for Black patients but not Hispanic patients.
The authors concluded that differences in hospitals’ rates of discharge to ASCUs accounted for much of the observed disparity. The findings are observational and do not establish causes; they point to hospital discharge planning and barriers to specialized care as areas for further attention.
In practice
For older adults with dementia discharged from hospital, access to nursing homes with Alzheimer special care units differed by race and ethnicity in this Medicare cohort. The disparities narrowed substantially after accounting for the hospital where patients received care, suggesting that hospital-level discharge patterns are an important part of the observed gap. Adjusted differences remained for Black patients, but not Hispanic patients, among those entering long-term care. Because this was an observational claims study, it does not establish why disparities occur or show that a particular discharge intervention will reduce them.
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JAMA Network Open: Racial and Ethnic Differences in Access to Alzheimer Special Care Units After Hospitalization ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.