The Relationships Between Vascular Risk, Cognition and Outcome in Late-Life Psychotic Depression

Abstract

difficulties, and baseline depression scores. We assessed risk of discharge to hospital (according to Medicare hospitalization claims) in the 30-day and 60-day periods following start of care. Results: Of 755 total eligible patients, 195 (25.8%) patients were hospitalized during the 60-day study period. At 30 days from start of care, 68 (15.5%) CAREPATH patients and 69 (22.0%) usual care patients were hospitalized. The 30-day risk of hospitalization among CAREPATH patients was approximately 30% lower compared to usual care (adjusted Relative Risk (RR) 1⁄4 0.70, p1⁄4.020). At 60 days from start of care, 103 (23.5%) CAREPATH patients were hospitalized and 92 (29.4%) usual care patients were hospitalized. The 60-day risk of hospitalization remained approximately 20% lower among CAREPATH patients (RR1⁄40.79, p1⁄4.055). Using cox proportional hazards models to account for individual differences in time at-risk, the risk of hospitalization was approximately 34% lower (adjusted Hazard Ratio (HR) 1⁄4 0.66, p1⁄4.015) among CAREPATH patients after 30 days, and approximately 29% lower (HR 1⁄4 0.71, p1⁄4.019) after 60 days. Conclusions: Patients receiving CAREPATH depression care were significantly less likely to experience acute care hospitalization during 30-day and 60-day Medicare home health episodes. Results suggest that depression care management may be an important element of routine home health and post-acute care practices, not only to treat depression but to reduce risk of adverse outcomes and associated medical costs.