JAMA Ophthalmology, June 2019
Patients with vision loss who are hospitalized for common illnesses may not be identified as needing special attention for their vision deficits. Morse et al. compared health care utilization for older adults with and without vision loss who were hospitalized for similar conditions. They found that those with severe visual impairment had longer hospital stays, higher readmission rates, and greater costs during and after hospitalization.
For this study, the authors looked at claims data from Medicare and the Clinformatics Data Mart. Individuals with vision loss were matched (1:1) to those with no visual impairment based on age, years since initial hospitalization, and other demographics. All patients were members of Medicare or a commercial health plan, and all had been hospitalized for a common illness such as congestive heart failure, major joint replacement, or pneumonia. Vision loss was categorized as either partial or severe. ICD-9-CM billing codes (369.xx) were used to classify those patients with severe vision loss (≥1 record of codes 369.0x to 369.4x), partial vision loss (≥1 record of 369.6x to 369.9x and no SVL code), or no vision loss (no record of any 369.xx code).
Main outcomes were lengths of stay, readmission rates, and hospital costs (during hospitalization and within 90 days after discharge). Multivariable logistic and linear-regression models were used to identify factors associated with these outcomes in each study arm. Data were analyzed for 2015 to 2018.
There were 6,165 Medicare beneficiaries with no vision loss (mean age, 82.0 years), 3,401 with partial vision loss (mean age, 80.4 years), and 2,764 with severe vision loss (mean age, 83.9). In the Clinformatics database, the number of patients in those categories were 5,929 individuals (mean age, 73.7 years), 3,515 (mean age, 71.8), and 2,414 (mean age, 76.6), respectively.
Hospital stays were longer, readmission rates were higher, and hospitalization costs (through 90 days following discharge) were greater for Medicare members with severe vision loss versus those with no visual impairment (mean stay, 6.48 vs. 5.26 days; mean readmission rate, 23.1% vs. 18.7%; mean costs, $64,711 vs. $61,060).
In addition, those with severe vision loss stayed 4% longer in the hospital (estimated ratio, 1.04; p = .02), had 22% higher readmission rates (odds ratio, 1.22; p = .007), and incurred 12% higher costs (estimated cost ratio, 1.12; p < .001). Results were similar for patients with commercial health plans.
In extrapolating their findings to nationwide hospitalization, the authors estimated that the additional cost of caring for patients with vision loss exceeds $500 million annually. In addition, they noted that addressing the vision deficits of hospitalized patients could result in substantial cost savings and better health outcomes. (Also see related commentary by David W. Parke II, MD, and Anne L. Coleman, MD, PhD, in the same issue.)
The original article can be found here.