Rituparna Bhattacharya1, Chan Shen2, Usha Sambamoorthi3. 1. Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA. Electronic address: rbhattacharya@hsc.wvu.edu. 2. Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA. 3. Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV 26506, USA.
Abstract
OBJECTIVE: We examined the association between depression and hospitalizations for Ambulatory Care Sensitive Conditions (H-ACSC) among Medicare beneficiaries with chronic physical conditions. METHODS: We used a retrospective longitudinal design using multiple years (2002-2009) of linked fee-for-service Medicare claims and survey data from Medicare Current Beneficiary Survey to create six longitudinal panels. We followed individuals in each panel for a period of 3-years; first year served as the baseline and subsequent 2-years served as the follow-up. We measured depression, chronic physical conditions and other characteristics at baseline and examined H-ACSC at follow-up. We identified chronic physical conditions from survey data and H-ACSC and depression from fee-for-service Medicare claims. We analyzed unadjusted and adjusted relationships between depression and the risk of H-ACSC with chi-square tests and logistic regressions. RESULTS: Among all Medicare beneficiaries, 9.3% had diagnosed depression. Medicare beneficiaries with depression had higher rates of any H-ACSC as compared to those without depression (13.6% vs. 7.7%). Multivariable regression indicated that, compared to those without depression, Medicare beneficiaries with depression were more likely to experience any H-ACSC. CONCLUSIONS: Depression was associated with greater risk of H-ACSC, suggesting that health care quality measures may need to include depression as a risk-adjustment variable.
OBJECTIVE: We examined the association between depression and hospitalizations for Ambulatory Care Sensitive Conditions (H-ACSC) among Medicare beneficiaries with chronic physical conditions. METHODS: We used a retrospective longitudinal design using multiple years (2002-2009) of linked fee-for-service Medicare claims and survey data from Medicare Current Beneficiary Survey to create six longitudinal panels. We followed individuals in each panel for a period of 3-years; first year served as the baseline and subsequent 2-years served as the follow-up. We measured depression, chronic physical conditions and other characteristics at baseline and examined H-ACSC at follow-up. We identified chronic physical conditions from survey data and H-ACSC and depression from fee-for-service Medicare claims. We analyzed unadjusted and adjusted relationships between depression and the risk of H-ACSC with chi-square tests and logistic regressions. RESULTS: Among all Medicare beneficiaries, 9.3% had diagnosed depression. Medicare beneficiaries with depression had higher rates of any H-ACSC as compared to those without depression (13.6% vs. 7.7%). Multivariable regression indicated that, compared to those without depression, Medicare beneficiaries with depression were more likely to experience any H-ACSC. CONCLUSIONS:Depression was associated with greater risk of H-ACSC, suggesting that health care quality measures may need to include depression as a risk-adjustment variable.
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