By Christopher Cheney
Vision-impaired hospital patients have worse clinical outcomes, more readmissions, longer length of stay, and higher costs of care than non-vision-impaired patients, recent research shows.
Vision impairment including blindness affects nearly 4 million U.S. adults, and the figure is expected to increase significantly with rising rates of macular degeneration, glaucoma, diabetic retinopathy, and other eye conditions.
Compared to hospital patients without vision impairment, the recent research found vision-impaired Medicare beneficiaries and patients with commercial health insurance had significantly higher healthcare utilization and costs during and immediately after hospitalization.
"Extrapolating these findings to older adults suggests that hospitalization of patients with vision loss is associated with excess estimated healthcare costs of more than $500 million annually," the researchers wrote.
The research features data collected from more than 12,000 patients with and without vision impairment. The study, which was published in JAMA Ophthalmology, includes several key data points:
•Compared to hospital patients with no vision impairment, Medicare beneficiaries with severe vision loss had longer mean lengths of stay, 6.48 days vs. 5.26 days.
• Medicare beneficiaries with severe vision loss had a 23.1% readmission rate, which was 4.4% higher than patients with no vision impairment.
• Medicare beneficiaries with severe vision loss had 12% higher costs of care compared to patients with no vision impairment.
• For older patients with vision impairment, the total excess cost of hospital care was estimated at more than $580 million.
"These findings suggest that identifying the presence of vision loss during hospitalization or the discharge-planning period and employing strategies to assist these patients may be associated with improved outcomes, fewer readmissions, shorter LOS, better patient satisfaction, and (if applied across the United States) a cost savings of more than $500 million annually," the researchers wrote.
Vision-impaired hospital patients are not typically targeted for special attention, which contributes to negative consequences, the researchers wrote. "Empirical evidence suggests that persons with vision loss may have difficulty following hospital routines and, once discharged, may struggle to read discharge orders and medication instructions, which may result in poor outcomes."
Hospitalization pose challenges for vision-impaired patients.
Documents such as consent forms, preadmission protocols, and post-discharge instructions are often inaccessible to vision-impaired patients. Many healthcare organizations are ill-equipped to address the needs of vision-impaired patients such as providing documents in larger fonts or braille. In an earlier study, only 23% of physician offices and hospitals offered large-print documents.
In the hospital setting, simple tasks can be daunting for vision-impaired patients, the researchers wrote.
"Indicating food choices, locating nursing call buttons, or identifying support staff can be difficult for hospitalized patients with vision loss. Ambulation is generally desirable during hospitalization to reduce risk of venous thrombosis and pressure ulcers. Yet for many patients with visual impairment, ambulation requires assistance from someone to address possible obstacles in hallways and patient rooms, which may increase the risk for injuries."
Caring for vision-impaired patients
The researchers say there are several measures that hospitals can deploy to meet the needs of vision-impaired patients:
• Patients should be evaluated during the admission process for their ability to read documents
• Patients who are identified with vision impairment should receive a hospital bracelet similar to bracelets provided to indicate fall risk that alert staff members to the need for additional assistance
• Visual impairment should be noted in the electronic health record to make sure proper accommodations are provided during hospitalization and discharge
• Care instructions should be provided to patients in accessible formats such as documents with large-font text
• Patients should receive referrals for eye-care follow up for newly identified vision impairment during hospitalization
"Although some costs may be incurred to make facilities and hospital personnel better equipped to care for these patients, the potential savings and improvement in quality of care may make this undertaking a good investment," the researchers wrote.
Christopher Cheney is the senior clinical care? editor at HealthLeaders.