Hospitalized patients with vision loss face worse outcomes for common illnesses

A study published in JAMA Ophthalmology found that hospitalized patients who are not identified with vision loss may not be receiving the special attention they need.

The authors estimated that $500 million each year is spent on additional care because of this.

Researchers hypothesized that this could result in worse outcomes, as patients with vision loss would be unable to read hospital orders and medication instructions.

Primary Care Optometry News corresponded with lead author Alan R. Morse, JD, PhD, president and CEO of Lighthouse Guild, regarding the goal of this study as well as what the findings mean for clinical practice.

“We were interested in understanding the relationship between degree of vision loss, that is, no or mild, moderate or severe, with length of stay and costs related to care following discharge, and on readmission rates and costs,” Morse said in the interview.

Investigators used data from the Medicare database and Clinformatics DataMart, identifying 6,165 patients with vision loss and matching them with individuals without vision loss. Matches were based on age, years from initial hospitalization, sex, race and ethnicity, urbanicity of residence and overall health. Both matches had the same health insurance and were hospitalized for common illnesses.

According to the study, outcomes included length of stay, rate of readmission as well as health care costs during hospitalization and 90 days after discharge.

Researchers found that Medicare beneficiaries with severe vision loss (SVL) had a 4% longer hospital stay, 22% higher odds of readmission and 12% higher costs.

“Our findings indicated that LOS, readmissions and cost were related to degree of vision loss,” Morse told PCON. “LOS itself was most likely the biggest contributor to excess cost, although we did not look at that specifically, as well as the higher rate of readmission within 90 days.”

Similar findings were observed for patients with commercial health insurance. Investigators extrapolated this data for patients nationwide and estimated that an additional $500 million was spent annually on the care for these patients.

“There are patient-centered actions that would not only reduce each of the negative outcomes, but would also alleviate much of the stress associated with hospital stays,” Morse said. “Understanding patient characteristics and needs prior to hospital admission and addressing them throughout their LOS as well as on discharge, not only for those with vision loss, has the potential to improve patient satisfaction as well as improve outcomes and costs, as well,” he said.

Researchers noted that hospital staff should consider factors such as vision loss, hearing loss and cognitive impairment at the patient’s time of admission as well as the discharge planning process. The study suggested that if a form of sensory impairment is found in a newly admitted patient, they could be given a bracelet and have an indicator placed on their room door, making the impairment known to hospital staff.

“We are now looking to identify specific elements that contribute to cost and add to higher levels of patient dissatisfaction, something known from earlier studies,” Morse said. “We discussed a number of the specific issues and ways in which hospitals can make their facilities and procedures more sensitive to their vision impaired patients. Hospitals should be sensitive to the specific needs of all their patients, whether or not they have vision loss. Eye care professionals should be sure their patient has proper eye wear and, if they have low vision, aids and devices that are appropriate for hospital use.” – by Scott Buzby

Disclosures : Morse reported grants from Linder Fund outside of the submitted work. Additionally, co-author Joshua D. Stein, MD, MS, reported grants from the National Eye Institute, Lighthouse Guild and Research to Prevent Blindness during the study. None of the other authors reported any relevant financial disclosures.