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Potentially preventable hospitalizations and use of preventive services among people with multiple sclerosis: Large cohort study, USA

  • Anam Khan
    Affiliations
    School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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  • Paul Lin
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109, USA
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  • Neil Kamdar
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109, USA

    Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, USA

    Department of Emergency Medicine, Michigan Medicine, University of Michigan, USA

    Department of Surgery, Michigan Medicine, University of Michigan, USA

    Department of Neurosurgery, Michigan Medicine, University of Michigan, USA
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  • Mark Peterson
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109, USA

    Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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  • Elham Mahmoudi
    Correspondence
    Corresponding author at: Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109, USA.
    Affiliations
    Institute for Healthcare Policy and Innovation, Michigan Medicine, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd., Building 14, Room G234, Ann Arbor, MI 48109, USA

    Department of Family Medicine, Michigan Medicine, University of Michigan, USA
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Published:August 11, 2022DOI:https://doi.org/10.1016/j.msard.2022.104105

      Highlights

      • The risk of potentially preventable hospitalizations (PPH) is double in people with MS than in those without MS (131.6 vs. 62.5 per 10,000).
      • People with MS are at five times higher risk of being hospitalized for urinary tract infections than those without MS.
      • Annual wellness visits are associated with a reduced risk of any PPH by almost half.
      • Efforts are needed to facilitate the use of preventive care among MS patients.

      Abstract

      Background

      Individuals with multiple sclerosis (MS) report barriers to accessing care, including receipt of preventive services. Potentially preventable hospitalization (PPH) is an important marker for access to, and receipt of timely care. However, few national studies have examined PPH risk in people with MS or considered the role of preventive care in reducing PPH risk among this patient population. Our objective was to examine PPH risk among adults with MS compared with their counterparts without MS.

      Methods

      Optum® Clinformatics® Data Mart (2007–2017) was used to identify 6198 individuals with an MS diagnosis and their propensity-score matched counterparts without MS. Diagnostic and procedural codes were used to identify the presence of preventive hospitalizations, which were defined as quality indicators by the Agency for Healthcare Research and Quality (AHRQ) during the 4-year follow-up period since the diagnosis of MS. Information on receipt of preventive services and office visits was also extracted. Adjusted generalized estimating equations were used to examine the association between MS diagnosis and PPHs. To examine the role of preventive services on odds of PPH amongst people with MS, we reported the adjusted marginal odds ratio (OR) and 95% confidence intervals (CI).

      Results

      The rate of any PPH among people with MS was double that of those without MS (131.6 vs 62.5 per 10,000). We identified higher odds of specific PPH indicators among people with MS compared to those without. Individuals with MS had 65% higher odds of hospitalization for pneumonia (OR=1.65, 95% CI: 1.01, 2.30), with similar significant findings observed for urinary tract infections (OR=4.90, 95% CI: 2.51, 9.57). In MS patients, receipt of preventive services, namely cholesterol screening (OR=0.76, 95% CI: 0.60, 0.95) and annual wellness visits were associated with lower odds of any PPH (OR=0.57, 95% CI: 0.43, 0.76).

      Conclusion

      People with MS were at a higher risk for PPHs compared with their counterparts without MS. Use of appropriate preventive services reduced the risk of PPH among the general population and among those with MS. More efforts are needed to encourage and facilitate the use of preventive care among people with MS. Receipt of timely and appropriate preventive care in this population may reduce the risk for PPH.

      Graphical abstract

      Keywords

      Abbreviations:

      AHRQ (Agency for Healthcare Research and Quality), BMD (bone mineral density), CI (confidence interval), COPD (chronic obstructive pulmonary disease), ECC (exlihauser comorbidity count), ICD (International Classification of Diseases), MS (Multiple Sclerosis), OR (odd ratio), PPH (potentially preventable hospitalization), PQI (Prevention Quality Indicator), UTI (urinary tract infection)
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