The association between early diagnosis of dementia and health care utilization in psychiatric hospitalization for behavioral and psychological symptoms

Abstract

AbstractBackgroundEarly diagnosis of dementia has been considered an effective strategy to reduce the healthcare cost for dementia but not conclusive. Our aim is to examine the association between early diagnosis of dementia and healthcare utilization in the first psychiatric hospitalization for behavioral and psychological symptoms.MethodsThis retrospective cohort study examined whether the diagnosis of dementia before index hospitalization affected healthcare management after the index hospitalization for 1972 elderly individuals between 2005 and 2015, using National Health Insurance claims data in Taiwan. Propensity scores, inverse probability of treatment weighting (IPTW), and regression analyses were used to adjust for confounding and examine the effect of early dementia diagnosis. The outcomes were chemical restraints, physical restraints, and healthcare utilization.ResultsAmong the 1,972 patients, 89.6% had an early diagnosis, and 10.4% had a delayed dementia diagnosis. The delayed dementia diagnosis group was younger and had less comorbidity. IPTW showed that the delayed diagnosis group received more chemical and physical restraints. The length of stay of index hospitalization in the delayed diagnosis group was 8 days longer than the early diagnosis group. Additionally, the delayed diagnosis group had significantly higher total medical expenses by NT$27,344 and higher total drug expenses by NT$1,912 than the early diagnosis group.ConclusionAn early diagnosis of dementia was associated with decreased use of physical and chemical restraints, shortened length of stay of acute hospitalization, and decreased overall healthcare costs in psychiatric hospital admissions compared with a delayed diagnosis.