Objective: This study examined the relationship between drinking that exceeds guideline-recommended limits and acute-care utilization for ambulatory-care-sensitive conditions (ACSCs) by older Medicare beneficiaries. Method: This secondary data analysis used the 2001-2006 Medicare Current Beneficiary Survey (unweighted n = 5,570 community dwelling, past-year drinkers, 65 years and older). Self-reported alcohol consumption (categorized as within guidelines, exceeding monthly but not daily limits, or heavy episodic) and covariates were used to predict ACSC hospitalization, emergency department visit not resulting in admission, and emergency department visit that did result in admission. Results: Heavy episodic drinking was significantly associated with higher likelihood of an ACSC emergency department visit not resulting in admission (adjusted odds ratio = 1.91, 95% CI: 1.11-3.30; p < .05). Drinking pattern was not significant for other ACSC measures. Discussion: Results partially support the hypothesis that excessive drinking may be related to ACSC acute-care utilization among older adults, suggesting increased risk of lower quality outpatient care.
Agency for Healthcare Research and Quality. ( 2008). Prevention quality indicators: Technical specifications . Rockville, MD: Author. Available from http://www.qualityindicators.ahrq.gov/pqi_download.htm
2.
American Geriatrics Society. (2006). Position paper: Alcohol use disorders in older adults. Annals of Long-Term Care, 14, 23-26.
3.
Anderson, P., Kaner, E., Wutzke, S., Funk, M., Heather, N., Wensing, M., et al. (2004). Attitudes and managing alcohol problems in general practice: An interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol, 39, 351-356.
4.
Arozullah, A.M., Lee, S.Y., Khan, T., Kurup, S., Ryan, J., Bonner, M., et al. (2006). The roles of low literacy and social support in predicting the preventability of hospital admission. Journal of General Internal Medicine, 21, 140-145.
5.
Babor, T.F., Steinberg, K., Anton, R., & Del Boca, F. ( 2000). Talk is cheap: Measuring drinking outcomes in clinical trials. Journal of Studies on Alcohol and Drugs, 61, 55-63.
6.
Balsa, A.I., Homer, J.F., Fleming, M.F., & French, M.T. ( 2008). Alcohol consumption and health among elders. The Gerontologist, 48, 622-636.
7.
Billings, J., Anderson, G.M., & Newman, L.S. ( 1996). Recent findings on preventable hospitalizations. Health Affairs (Millwood), 15, 239-249.
8.
Billings, J., Zeitel, L., Lukomnik, J., Carey, T.S., Blank, A.E., & Newman, L. ( 1993). Impact of socioeconomic status on hospital use in New York City. Health Affairs (Millwood), 12, 162-173.
9.
Blazer, D.G., & Wu, L.T. ( 2009). The epidemiology of at-risk and binge drinking among middle-aged and elderly community adults: National Survey on Drug Use and Health. American Journal of Psychiatry, 166, 1162-1169.
10.
Blow, F.C., Brockmann, L.M., & Barry, K.L. ( 2004). Role of alcohol in late-life suicide. Alcoholism: Clinical and Experimental Research, 28(5 Suppl.), 48S-56S.
11.
Blustein, J., Hanson, K., & Shea, S. ( 1998). Preventable hospitalizations and socioeconomic status . Health Affairs (Millwood), 17, 177-189.
12.
Buccaneer Computer Systems and Services. ( 2009). Chronic condition data warehouse user manual (Version 1.5). Baltimore: Center for Medicare and Medicaid Services.
13.
Bynum, J.P., Rabins, P.V., Weller, W., Niefeld, M., Anderson, G.F., & Wu, A.W. ( 2004). The relationship between a dementia diagnosis, chronic illness, Medicare expenditures, and hospital use. Journal of the American Geriatrics Society, 52, 187-194.
14.
Centers for Medicare and Medicaid Services. (n.d.). Medicare current beneficiary survey. Available from http://www.cms.gov/mcbs
15.
Clark, R.E., Weir, S., Ouellette, R.A., Zhang, J., & Baxter, J.D. ( 2009). Beyond health plans: Behavioral health disorders and quality of diabetes and asthma care for Medicaid beneficiaries. Medical Care, 47, 545-552.
16.
Cohen, S.B. ( 1997). An evaluation of alternative PC-based software packages developed for the analysis of complex survey data. Journal of the American Statistical Association, 51, 285-292.
17.
Culler, S.D., Parchman, M.L., & Przybylski, M. (1998). Factors related to potentially preventable hospitalizations among the elderly. Medical Care , 36, 804-817.
18.
Deehan, A., Templeton, L., Taylor, C., Drummond, C., & Strang, J. ( 1998). Low detection rates, negative attitudes and the failure to meet the "Health of the Nation" alcohol targets: Findings from a national survey of GPs in England and Wales. Drug and Alcohol Review , 17, 249-258.
19.
Desai, M.M., Rosenheck, R.A., Druss, B.G., & Perlin, J.B. ( 2002). Mental disorders and quality of diabetes care in the veterans health administration. American Journal of Psychiatry , 159, 1584-1590.
20.
Druss, B.G., Rask, K., & Katon, W.J. ( 2008). Major depression, depression treatment and quality of primary medical care. General Hospital Psychiatry, 30, 20-25.
21.
DxCG. (2009). Products and services, RiskSmart Stand Alone. Retrieved October 27, 2009 , from http://www.dxcg.com/products-services/risksmart-stand-alone.asp
22.
Epstein, A.J. ( 2001). The role of public clinics in preventable hospitalizations among vulnerable populations. Health Services Research, 36, 405-420.
23.
Falik, M., Needleman, J., Wells, B.L., & Korb, J. ( 2001). Ambulatory care sensitive hospitalizations and emergency visits: Experiences of Medicaid patients using federally qualified health centers. Medical Care, 39, 551-561.
24.
Ford, J.D., Trestman, R.L., Tennen, H., & Allen, S. ( 2005). Relationship of anxiety, depression and alcohol use disorders to persistent high utilization and potentially problematic under-utilization of primary medical care. Social Science & Medicine, 61, 1618-1625.
25.
Freidman, P.D., McCullough, D., Chin, M.H., & Saitz, R. ( 2000). Screening and intervention for alcohol problems: A national survey of primary care physicians and psychiatrists. Journal of General Internal Medicine, 15, 84-91.
26.
Friedman, B., & Basu, J. ( 2004). The rate and cost of hospital readmissions for preventable conditions. Medical Care Research and Review, 61, 225-240.
27.
Gill, J.M., & Mainous, A.G., III. (1998). The role of provider continuity in preventing hospitalizations. Archives of Family Medicine , 7, 352-357.
28.
Girard, D.D., Partridge, R.A., Becker, B., & Bock, B. ( 2004). Alcohol and tobacco use in the elder emergency department patient: Assessment of rates and medical care utilization. Academic Emergency Medicine, 11, 378-382.
29.
Hazelton, L.D., Sterns, G.L., & Chisholm, T. ( 2003). Decision-making capacity and alcohol abuse: Clinical and ethical considerations in personal care choices. General Hospital Psychiatry, 25, 130-135.
30.
Health Resources and Services Administration. (n.d.). Primary care health professional shortage areas. Available from http://datawarehouse.hrsa.gov/hpsadetail.aspx
31.
Himelhoch, S., Weller, W.E., Wu, A.W., Anderson, G.F., & Cooper, L.A. ( 2004). Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries. Medical Care , 42, 512-521.
32.
Kaner, E., Bland, M., Cassidy, P., Coulton, S., Deluca, P., Drummond, C., et al. (2009). Screening and brief interventions for hazardous and harmful alcohol use in primary care: A cluster randomised controlled trial protocol. BMC Public Health, 9, 287.
33.
Katz, S., Ford, A.B., Moskowitz, R.W., Jackson, B.A., & Jaffe, M.W. ( 1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA, 185, 914-919.
34.
Kunz, J.L. ( 1997). Alcohol use and reported visits to health professionals: An exploratory study. Journal of Studies on Alcohol and Drugs , 58, 474-479.
35.
Laditka, J.N., Laditka, S.B., & Mastanduno, M.P. (2003). Hospital utilization for ambulatory care sensitive conditions: Health outcome disparities associated with race and ethnicity. Social Science & Medicine, 57, 1429-1441.
36.
Lemeshow, S., Letenneur, L., Dartigues, J.F., Lafont, S., Orgogozo, J.M., & Commenges, D. ( 1998). Illustration of analysis taking into account complex survey considerations: The association between wine consumption and dementia in the PAQUID study. Personnes Ages Quid. American Journal of Epidemiology, 148, 298-306.
37.
Li, C., Friedman, B., Conwell, Y., & Fiscella, K. ( 2007). Validity of the Patient Health Questionnaire 2 (PHQ-2) in identifying major depression in older people. Journal of the American Geriatrics Society, 55, 596-602.
38.
Li, Y., Glance, L.G., Cai, X., & Mukamel, D.B. ( 2008). Mental illness and hospitalization for ambulatory care sensitive medical conditions. Medical Care, 46, 1249-1256.
39.
Logan, J.E., Riley, A.W., & Barker, L.E. ( 2008). Parental mental and pain-related health and pediatric ambulatory care sensitive emergency department visits and hospitalizations . Health Services Research, 43, 656-674.
40.
McCall, N., Brody, E., Mobley, L., & Subramanian, S. (2004, June). Investigation of increasing rates of hospitalization for ambulatory care sensitive conditions among Medicare Fee-for-Service beneficiaries (Final report RTI Project Number 08686.001.002, CMS Contract No. 500-00-0029). Research Triangle Park, NC: RTI International.
41.
Merrick, E.L., Hodgkin, D., Garnick, D.W., Horgan, C.M., Panas, L., Ryan, M., et al. (2008). Unhealthy drinking patterns and receipt of preventive medical services by older adults. Journal of General Internal Medicine, 23, 1741-1748.
42.
Merrick, E.L., Horgan, C.M., Hodgkin, D., Garnick, D.W., Houghton, S.F., Panas, L., et al. (2008). Unhealthy drinking patterns in older adults: Prevalence and associated characteristics. Journal of the American Geriatrics Society, 56, 214-223.
43.
Moore, A.A., Morgenstern, H., Harawa, N.T., Fielding, J.E., Higa, J., & Beck, J.C. ( 2001). Are older hazardous and harmful drinkers less likely to participate in health-related behaviors and practices as compared with nonhazardous drinkers? Journal of the American Geriatrics Society, 49, 421-430.
44.
Moos, R.H., Brennan, P.L., Schutte, K.K., & Moos, B.S. ( 2004). High-risk alcohol consumption and late-life alcohol use problems. American Journal of Public Health, 94, 1985-1991.
45.
National Institute on Alcohol Abuse and Alcoholism. ( 2005). Helping patients who drink too much: A clinician’s guide. Retrieved June 5, 2008, from http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/guide.pdf
46.
Niefeld, M.R., Braunstein, J.B., Wu, A.W., Saudek, C.D., Weller, W.E., & Anderson, G.F. (2003). Preventable hospitalization among elderly Medicare beneficiaries with type 2 diabetes. Diabetes Care, 26, 1344-1349.
47.
Oster, A., & Bindman, A.B. ( 2003). Emergency department visits for ambulatory care sensitive conditions: Insights into preventable hospitalizations. Medical Care, 41, 198-207.
48.
Ozminkowski, R.J., Goetzel, R.Z., Shechter, D., Stapleton, D.C., Baser, O., & Lapin, P. ( 2006). Predictors of preventive service use among Medicare beneficiaries . Health Care Financing Review, 27(3), 5-23.
49.
Rathore, S.S., Wang, Y., Druss, B.G., Masoudi, F.A., & Krumholz, H.M. (2008). Mental disorders, quality of care, and outcomes among older patients hospitalized with heart failure: An analysis of the national heart failure project. Archives of General Psychiatry, 65, 1402-1408.
50.
Rice, C., & Duncan, D.F. ( 1995). Alcohol use and reported physician visits in older adults . Preventive Medicine, 24, 229-234.
51.
Rice, D.P., Conell, C., Weisner, C., Hunkeler, E.M., Fireman, B., & Hu, T.W. ( 2000). Alcohol drinking patterns and medical care use in an HMO setting. Journal of Behavioral Health Services & Research , 27, 3-16.
52.
Saitz, R. ( 2003). Medical and surgical complications of addiction. In A. S. T. Graham, M. Mayo-Smith, R. Ries, & B. B. Wilford (Eds.), Principles of addiction medicine (3rd ed., pp. 1027-1052). Chevy Chase, MD: American Society of Addiction Medicine .
53.
Shelkey, M., & Wallace, M. ( 1999). Katz Index of independence in activities of daily living . Journal of Gerontological Nursing, 25, 8-9.
54.
STATA Corporation. (n.d.). STATA version 9.0 [Computer software]. College Station, TX: Author.
55.
Wang, M.C., Rosen, A.K., Kazis L., Loveland, S., Anderson, J., & Berlowitz, D. ( 2000). Correlation of risk adjustment measures based on diagnoses and patient self-reported health status. Health Services & Outcomes Research Methodology, 1, 351-365.
56.
Weissman, J.S., Gatsonis, C., & Epstein, A.M. ( 1992). Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA, 268, 2388-2394.
Zeng, F., O’Leary, J.F., Sloss, E.M., Lopez, M.S., Dhanani, N., & Melnick, G. ( 2006). The effect of Medicare health maintenance organizations on hospitalization rates for ambulatory care-sensitive conditions. Medical Care, 44, 900-907.
59.
Zhao, Y., Ash, A.S., Ellis, R.P., & Slaughter, J.P. (2002). Disease burden profiles: An emerging tool for managing managed care. Health Care Management Science, 5, 211-219.
60.
Zhao, Y., Ellis, R.P., Ash, A.S., Calabrese, D., Ayanian, J.Z., Slaughter, J.P., et al. (2001). Measuring population health risks using inpatient diagnoses and outpatient pharmacy data. Health Services Research, 36, 180-193.
