Changes in Health Care Use by Mexican American Medicare Beneficiaries Before and After a Diagnosis of Dementia

Downer, Brian; Snih, Soham Al; Chou, Lin‐Na; Kuo, Yong–Fang; Raji, Mukaila; Markides, Kyriakos S.; Ottenbacher, Kenneth J.

doi:10.1093/gerona/glaa236

Cited by 18 publications

(14 citation statements)

References 45 publications

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“…Furthermore, Hispanics may more readily accept provider advice compared to other races/ethnicities [ 43 ]. For instance, Hispanics have decreased hospitalization and emergency department visitations after diagnosis of AD-related dementia compared to prior to diagnosis [ 43 ]. This may indicate that Hispanics are more proactive in using their newfound health knowledge to prevent further complications.…”

Section: Discussionmentioning

confidence: 99%

Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer’s Disease: an observational analysis

Browning

Tsang

Dong

et al. 2022

BMC Health Serv Res

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Background Alzheimer’s Disease (AD) is the mostcommon cause of dementia, a neurological disorder characterized by memory loss and judgment impairment. Hyperlipidemia, a commonly co-occurring condition, should be treated to prevent associated complications. Medication adherence may be difficult for individuals with AD due to the complexity of AD management. Comprehensive Medication Reviews (CMRs), a required component of Medicare Part D Medication Therapy Management (MTM), have been shown to improve medication adherence. However, many MTM programs do not target AD. Additionally, racial/ethnic disparities in MTM eligibility have been revealed. Thus, this study examined the effects of CMR receipt on reducing racial/ethnic disparities in the likelihood of nonadherence to hyperlipidemia medications (statins) among the AD population. Methods This retrospective study used 2015-2017 Medicare data linked to the Area Health Resources Files. The likelihood of nonadherence to statin medications across racial/ethnic groups was compared between propensity-score-matched CMR recipients and non-recipients in a ratio of 1 to 3. A difference-in-differences method was utilized to determine racial/ethnic disparity patterns using a logistic regression by including interaction terms between dummy variables for CMR receipt and each racial/ethnic minority group (non-Hispanic Whites, or Whites, as reference). Results The study included 623,400 Medicare beneficiaries. Blacks and Hispanics had higher statin nonadherence than Whites: Compared to Whites, Blacks’ nonadherence rate was 4.53% higher among CMR recipients and 7.35% higher among non-recipients; Hispanics’ nonadherence rate was 2.69% higher among CMR recipients and 7.38% higher among non-recipients. Differences in racial/ethnic disparities between CMR recipients and non-recipients were significant for each minority group (p < 0.05) except Others. The difference between Whites and Hispanics in the odds of statin nonadherence was 11% lower among CMR recipients compared to non-recipients (OR = 0.89; 95% Confidence Interval = 0.85-0.94 for the interaction term between dummy variables for CMR and Hispanics). Interaction terms between dummy variables for CMR and other racial/ethnic minorities were not significant. Conclusions Receiving a CMR was associated with a disparity reduction in nonadherence to statin medications between Hispanics and Whites among patients with AD. Strategies need to be explored to increase the number of MTM programs that target AD and promote CMR completion.

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Section: Discussionmentioning

confidence: 99%

Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer’s Disease: an observational analysis

Browning

Tsang

Dong

et al. 2022

BMC Health Serv Res

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“…We found some researches studying only a portion of healthcare use using MCA but conducted in populations different from ours. [31][32][33][34][35] Overall, studies describing healthcare use before and after ADRD identification showed an increased healthcare use before ADRD identification followed by an increased, 16,18 decreased 13,14 or stable 17 healthcare use after ADRD identification. If studies investigated healthcare trajectories before, after, or before and after an incident ADRD diagnosis, to our knowledge, none studied the association between healthcare use before ADRD diagnosis and future favorable healthcare trajectories after ADRD diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, no study confronted, with such wide approach, the healthcare use before ADRD identification and a long‐term healthcare trajectory after ADRD. Some studies described healthcare use before and after ADRD identification, however none confronted healthcare use in these two periods 13,14,16–18 . Therefore, the extent to which some patterns of healthcare use preceding ADRD may be more prone to further favorable healthcare trajectories is unknown.…”

Section: Introductionmentioning

confidence: 99%

“…A frequent late ADRD diagnosis is described 7,8 which may induce erratic healthcare trajectory, 9 sometimes due to a lack of regular and coordinated ambulatory care. If literature described healthcare use before ADRD identification, it mostly focused on a portion of healthcare use [10][11][12][13][14][15][16][17] (i.e. primary care, emergency room visits, hospitalization, home care).…”

mentioning

confidence: 99%

“…Some studies described healthcare use before and after ADRD identification, however none confronted healthcare use in these two periods. 13,14,[16][17][18] Therefore, the extent to which some patterns of healthcare use preceding ADRD may be more prone to further favorable healthcare trajectories is unknown. In a previous study, we described 5-year overall perspective of healthcare trajectories of subjects with ADRD and categorized as favorable or not.…”

mentioning

confidence: 99%

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Healthcare use patterns before Alzheimer's disease and related diseases identification and future healthcare trajectory

Couret

Lapeyre‐Mestre

Gombault‐Datzenko

et al. 2022

Int J Geriat Psychiatry

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Objectives A frequent late Alzheimer's Disease and Related Diseases (ADRD) identification is described and may induce erratic health resource use. We aimed to describe healthcare use patterns preceding ADRD identification. Methods We studied persons aged 65 or older, identified with incident ADRD in 2012 in the French health insurance database. Healthcare use covering a wide range of care in ambulatory and hospital settings during the period ranging from 18 to six months before ADRD identification was studied. The main dimensions of healthcare use patterns before ADRD identification were investigated in three age groups (65–74, 75–84, ≥85) through a multiple correspondence analysis. These dimensions were secondarily interpreted according to the 5‐year healthcare trajectory following ADRD identification, qualified as favorable (or not) by experts in the field. Results This research studied 36,990 subjects. Four dimensions raised in each age group. Two dimensions' interpretations were retrieved in all age groups: intensity of healthcare use, functional dependency. However, their rank differed along with the qualification of the future healthcare trajectory. Some specificities appeared in some age group. In the 65–74 and 75–84 years groups, there were dimensions reflecting healthcare use related to psychiatric or psycho‐behavioral disorders. In the ≥85 group, two dimensions reflected dependency related to other comorbidities, and organised medical follow‐up. Conclusion Several dimensions emerged in line with erratic trajectories before ADRD identification. They underlined the need for actions towards ADRD identification.

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Annual Wellness Visits and Early Dementia Diagnosis Among Medicare Beneficiaries

Tzeng,

Raji,

Shan

et al. 2024

JAMA Netw Open

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ImportanceEarly recognition of cognitive impairment is key to optimal dementia care. No previous research has examined the probability of developing mild cognitive impairment (MCI) or Alzheimer disease and related dementias (ADRD) at 5-year follow-up among older adult Medicare beneficiaries by receipt of an annual wellness visit (AWV).ObjectiveTo assess the association of incident AWV with the first ADRD or MCI diagnosis among older adults with Medicare fee-for-service benefits.Design, Setting, and ParticipantsThis retrospective population-based cohort study used 100% Texas fee-for-service Medicare data from 2015 to 2022. Participants comprised 549 516 community-dwelling Medicare beneficiaries aged 68 years or older in 2018, with complete Medicare fee-for-service Parts A and B and no Medicare Advantage plan enrollment for 2015 to 2018.ExposureMedicare AWVs.Main Outcomes and MeasuresThe first MCI or ADRD diagnosis (reported as MCI or ADRD diagnosis, MCI diagnosis, and ADRD diagnosis) from the AWV index date in 2018 through December 31, 2022.ResultsIn this cohort study of 549 516 Medicare beneficiaries with no diagnosis of MCI or ADRD in 2015 to 2017 (mean [SD] age, 76.7 [6.6] years; 289 932 women [52.8%]), 66 433 (12.1%) had an incident AWV in 2018. Annual wellness visit recipients were more likely than those who did not receive an AWV to be female, to be non-Hispanic White (followed by Hispanic, non-Hispanic Black, and other), to have more education, to reside in a metropolitan area, to have more comorbidities, and to have a primary care professional in the 12 months before the AWV index date. After propensity score matching, AWV receipt was associated with a 21% increase in MCI diagnosis (hazard ratio, 1.21 [95% CI, 1.16-1.27]) and a 4% increase in ADRD diagnosis (hazard ratio, 1.04 [95% CI, 1.02-1.06]). The increase in MCI diagnosis associated with AWV was larger when the AWV was censored or treated as a time-dependent covariate in the follow-up period.Conclusions and RelevanceThese findings indicate that AWV recipients had a timelier first MCI diagnosis than those who did not receive an AWV, but first ADRD diagnosis differed little. This study suggests that the Medicare AWV health policy may increase MCI identification, prompting more specialized care.

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Changes in Health Care Use by Mexican American Medicare Beneficiaries Before and After a Diagnosis of Dementia

Cited by 18 publications

References 45 publications

Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer’s Disease: an observational analysis

Effects of Medicare comprehensive medication review on racial/ethnic disparities in nonadherence to statin medications among patients with Alzheimer’s Disease: an observational analysis

Healthcare use patterns before Alzheimer's disease and related diseases identification and future healthcare trajectory

Annual Wellness Visits and Early Dementia Diagnosis Among Medicare Beneficiaries

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