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Original Investigation
April 4, 2019

Association of Vision Loss With Hospital Use and Costs Among Older Adults

Author Affiliations
  • 1Lighthouse Guild, New York, New York
  • 2Department of Ophthalmology, Columbia University, New York, New York
  • 3Department of Ophthalmology, New York University School of Medicine, New York
  • 4Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor
  • 5Center for Eye Policy and Innovation, University of Michigan, Ann Arbor
  • 6Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor
JAMA Ophthalmol. 2019;137(6):634-640. doi:10.1001/jamaophthalmol.2019.0446
Key Points

Question  Do hospitalized patients with vision loss experience greater resource use and costs compared with hospitalized patients without vision loss?

Findings  In this study of 12 330 Medicare beneficiaries and 11 858 commercial health insurance enrollees with or without vision loss, severe vision loss was associated with longer mean length of stay, higher readmission rates, and higher costs during hospitalization and 90 days after discharge.

Meaning  These results suggest that, by addressing vision-related issues, opportunities exist to reduce lengths of stay, readmission rates, resource use, and costs while enhancing outcomes and patient satisfaction.

Abstract

Importance  Patients with vision loss who are hospitalized for common illnesses are often not identified as requiring special attention. This perception, however, may affect the outcomes, resource use, and costs for these individuals.

Objective  To assess whether the mean hospitalization lengths of stay, readmission rates, and costs of hospitalization differed between individuals with vision loss and those without when they are hospitalized for similar medical conditions.

Design, Setting, and Participants  This analysis of health care claims data used 2 sources: Medicare database and Clinformatics DataMart. Individuals with vision loss were matched 1:1 to those with no vision loss (NVL), on the basis of age, years from initial hospitalization, sex, race/ethnicity, urbanicity of residence, and overall health. Both groups had the same health insurance (Medicare or a commercial health plan), and all had been hospitalized for common illnesses. Vision loss was categorized as either partial vision loss (PVL) or severe vision loss (SVL). Data were analyzed from April 2015 through April 2018.

Main Outcomes and Measures  The outcomes were lengths of stay, readmission rates, and health care costs during hospitalization and 90 days after discharge. Multivariable logistic and linear regression models were built to identify factors associated with these outcomes among the NVL, PVL, and SVL groups.

Results  Among Medicare beneficiaries, 6165 individuals with NVL (with a mean [SD] age of 82.0 [8.3] years, and 3833 [62.2%] of whom were female) were matched to 6165 with vision loss. Of those with vision loss, 3401 (55.2%) had PVL and 2764 (44.8%) had SVL. In the Clinformatics DataMart database, 5929 individuals with NVL (with a mean [SD] age of 73.7 [15.1] years, and 3587 [60.5%] of whom were female) were matched to 5929 individuals with vision loss. Of the commercially insured enrollees with vision loss, 3515 (59.3%) had PVL and 2414 (40.7%) had SVL. Medicare enrollees with SVL, compared with those with NVL, had longer mean lengths of stay (6.48 vs 5.26 days), higher readmission rates (23.1% vs 18.7%), and higher hospitalization and 90-day postdischarge costs ($64 711 vs $61 060). Compared with those with NVL, Medicare beneficiaries with SVL had 4% longer length of stay (estimated ratio, 1.04; 95% CI, 1.01-1.07; P = .02), 22% higher odds of readmission (odds ratio, 1.22; 95% CI, 1.06-1.41; P = .007), and 12% higher costs (estimated cost ratio, 1.12; 95% CI, 1.06-1.18; P < .001). Similar findings were obtained for those with commercial health insurance. When these findings were extrapolated to hospitalizations of patients with vision loss nationwide, an estimated amount of more than $500 million in additional costs annually were spent caring for these patients.

Conclusions and Relevance  These findings suggest that opportunities for improving outcomes and reducing costs exist in addressing patients’ vision loss and concomitant functional difficulties during hospitalization and thereafter.

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