Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare

Amjad, Halima; Carmichael, Donald; Austin, Andrea M.; Chang, Chiang Hua; Bynum, Julie

doi:10.1001/jamainternmed.2016.3553

Cited by 146 publications

(170 citation statements)

References 49 publications

Supporting

Mentioning

158

Contrasting

Unclassified

Order By: Relevance

“…Case management was associated with a low reduction on risk of nursing home admission up to 18 months (when intervention duration was < 2 years) (579;580), but did not affect resource utilisation or healthcare costs over 1 year. However, continuity of care (patients seeing fewer different clinicians, despite their comorbidities) is associated with less hospital admissions and lower costs of care (584). Few studies have specifically examined cost-effectiveness (578;580)..…”

Section: Studies Of Case Management Models For People With Dementiamentioning

confidence: 99%

Dementia prevention, intervention, and care

et al. 2017

View full text Add to dashboard Cite

People with dementia are usually older, often have co-morbidities and may need help in coping with these illnesses. A third of older people now die with dementia and all professionals working in endof-life care need to make this a central part of their planning and communication. In this commission, we have detailed evidence-based approaches to dementia and its symptoms. Services should be available, scalable and give value. As there are limited resources, professionals and services need to use what works, not use what is ineffective, and be aware of the difference. Overall, there is good potential for prevention and, once someone develops dementia, for care to be high-quality, accessible, and give value to an under-served, growing population. Effective dementia prevention and care could transform the future for society and vastly improve living and dying for individuals with dementia and their families. Acting now on what we already know can make this difference happen. Key Messages 1 There are increasing numbers of people with dementia globally although incidence in some countries has decreased. 2 Be ambitious about prevention: We recommend energetically treating hypertension in middle aged and older people without dementia to reduce dementia incidence. Interventions for other risk factors, including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes and obesity; may have the potential of delaying or preventing a third of dementias. 3 Treat cognitive symptoms: To maximise cognition, people with Alzheimer's dementia or Dementia with Lewy Bodies should be offered Cholinesterase Inhibitors (ChEIs)at all stages, or memantine for severe dementia. ChEIs are not effective in Mild Cognitive Impairment. 4 Individualise dementia care: Good dementia care spans medical, social and supportive care, should be tailored to unique individual and cultural needs, preferences, priorities, and should incorporate support for the family carers 5 Care for family carers. Family carers are at high risk of depression. Effective interventions reduce the risk and treat the symptoms, include START (Strategies for Relatives) or REACH (Resources for Enhancing Alzheimer's Caregiver Health intervention) and should be made available. 6 Plan for the future. People with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis. 7 Protect people with dementia. People with dementia and society require protection from possible risks of the condition, including self-neglect, vulnerability including to exploitation, managing money, driving or using weapons. Risk assessment and management at all stages of the disease is essential but it should be balanced against the persons' right to autonomy. 8 Manage neuropsychiatric symptoms. Management of the neuropsychiatric symptoms of dementia including agitation, low mood or psyc...

show abstract

Section: Studies Of Case Management Models For People With Dementiamentioning

confidence: 99%

Dementia prevention, intervention, and care

et al. 2017

View full text Add to dashboard Cite

show abstract

“…A group of researchers found that individuals with dementia whose care was concentrated within a smaller number of clinicians had fewer hospitalizations and emergency department visits and lower health care spending overall compared with individuals whose care was dispersed across a larger number of clinicians. 587 More research is needed to understand whether continuity of care is a strategy for decreasing unnecessary health care use for people with Alzheimer's or other dementias. The Alzheimer's Association commissioned a study of the potential cost savings of early diagnosis, 590 assuming that 88% of individuals who will develop Alzheimer's disease would be diagnosed in the MCI phase rather than the dementia phase or not at all.…”

Section: Use and Costs Of Health Care And Long-term Care Services By mentioning

confidence: 99%

2020 Alzheimer's disease facts and figures

2020

Alzheimer's & Dementia

2,038

653

View full text Add to dashboard Cite

This article describes the public health impact of Alzheimer's disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the future challenges of meeting care demands for the growing number of people living with Alzheimer's dementia in the United States with a particular emphasis on primary care. By mid‐century, the number of Americans age 65 and older with Alzheimer's dementia may grow to 13.8 million. This represents a steep increase from the estimated 5.8 million Americans age 65 and older who have Alzheimer's dementia today. Official death certificates recorded 122,019 deaths from AD in 2018, the latest year for which data are available, making Alzheimer's the sixth leading cause of death in the United States and the fifth leading cause of death among Americans age 65 and older. Between 2000 and 2018, deaths resulting from stroke, HIV and heart disease decreased, whereas reported deaths from Alzheimer's increased 146.2%. In 2019, more than 16 million family members and other unpaid caregivers provided an estimated 18.6 billion hours of care to people with Alzheimer's or other dementias. This care is valued at nearly $244 billion, but its costs extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes. Average per‐person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2020 for health care, long‐term care and hospice services for people age 65 and older with dementia are estimated to be $305 billion. As the population of Americans living with Alzheimer's dementia increases, the burden of caring for that population also increases. These challenges are exacerbated by a shortage of dementia care specialists, which places an increasing burden on primary care physicians (PCPs) to provide care for people living with dementia. Many PCPs feel underprepared and inadequately trained to handle dementia care responsibilities effectively. This report includes recommendations for maximizing quality care in the face of the shortage of specialists and training challenges in primary care.

show abstract

“…Continuity of care and emergency department visits are two indicators that notably worsened over time. Two studies exploring the association of continuity of care and health service use among persons with dementia found that higher levels of continuity were associated with a decreased risk of emergency department use . Interventions targeting improved continuity of care in persons newly diagnosed with dementia may limit acute care hospital use in the year following diagnosis, but the literature in this area remains scarce and requires further study.…”

Section: Discussionmentioning

confidence: 99%

Sex Differences in Dementia Primary Care Performance and Health Service Use: A Population‐Based Study

Sourial

Vedel

Godard‐Sebillotte

et al. 2020

J American Geriatrics Society

View full text Add to dashboard Cite

OBJECTIVES: Growing evidence points to underlying sex differences in the risk factors and clinical presentation of dementia. It is unclear, however, whether sex differences also exist in the management and healthcare utilization of persons with dementia. We compared primary care performance and health service use indicators for newly identified men and women with dementia in Ontario, Canada, over a 12-year period. DESIGN: Population-based, repeated cohort study between 2002 and 2014. SETTING: Ontario, Canada. PARTICIPANTS: A total of 318 350 community-dwelling adults, aged 65 years and older, newly identified with dementia, followed for up to 1 year. MEASUREMENTS: Eighteen indicators of primary care performance and health service use were assessed. RESULTS: Approximately 60% of the study population were women. Few differences in the indicators were observed between sexes, although men had fewer diagnoses first recorded by the family physician, more visits to noncognition specialists, less use of home care, more hospitalizations and readmissions, and longer discharge delays. Most indicators remained relatively stable over time for both men (median relative change = 13.7%; interquartile range [IQR] = 4.5%-29.7%) and women (median relative change = 15.7%; IQR = 5.9%-31.5%). Notable improvements over time for both sexes included access to an interprofessional primary care team, use of home care, and decreased use of long-term care. Areas of worsening included a higher occurrence of emergency department visits, lower continuity of care, and longer discharge delays. CONCLUSION: These findings raise awareness on the similarities and differences in management and health system use for men and women newly diagnosed with dementia, particularly the imbalance in hospital and home care use. As health systems continue to adapt to meet the needs of the growing dementia population, policy makers and clinicians should be mindful to develop care plans and interventions that consider the influence of sex on the need for services.

show abstract

Continuity of Care and Health Care Utilization in Older Adults With Dementia in Fee-for-Service Medicare

Cited by 146 publications

References 49 publications

Dementia prevention, intervention, and care

Dementia prevention, intervention, and care

2020 Alzheimer's disease facts and figures

Sex Differences in Dementia Primary Care Performance and Health Service Use: A Population‐Based Study

Contact Info

Product

Resources

About