Differences in service utilization at an urban tribal health organization before and after Alzheimer's disease or related dementia diagnosis: A cohort study

Schaefer, Krista R; Noonan, Carolyn; Mosley, Michael; Smith, Julia; Galbreath, Donna; Fenn, David; Robinson, Renee; Manson, Spero M.

doi:10.1016/j.jalz.2019.06.4945

Cited by 10 publications

(15 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Had these latter two variables been available, they may have improved the performance of Model 2. Additionally, in a previous study with the SCF population, behavioral health conditions and PHQ‐9 scores were not associated with suicide attempt, while utilization, opioid dispense, and poisoning/overdose diagnoses were associated (Schaefer et al, 2019). This may explain in part why the inclusion of behavioral health conditions on the day of the visit and PHQ‐9 scores, both prior and day of, in Model 2 did not greatly improve performance over Model 1 which already included utilization and prescriptions.…”

Section: Discussionmentioning

confidence: 89%

Validating a predictive algorithm for suicide risk with Alaska Native populations

Shaw

Beans

Noonan

et al. 2022

Suicide & Life Threat Behav

Self Cite

View full text Add to dashboard Cite

Introduction:The American Indian/Alaska Native (AI/AN) suicide rate in Alaska is twice the state rate and four times the U.S. rate. Healthcare systems need innovative methods of suicide risk detection. The Mental Health Research Network (MHRN) developed suicide risk prediction algorithms in a general U.S. patient population. Methods:We applied MHRN predictors and regression coefficients to electronic health records of AI/AN patients aged ≥13 years with behavioral health diagnoses and primary care visits between October 1, 2016, and March 30, 2018. Logistic regression assessed model accuracy for predicting and stratifying risk for suicide attempt within 90 days after a visit. We compared expected to observed risk and assessed model performance characteristics.Results: 10,864 patients made 47,413 primary care visits. Suicide attempt occurred after 589 (1.2%) visits. Visits in the top 5% of predicted risk accounted for 40% of actual attempts. Among visits in the top 0.5% of predicted risk, 25.1% were followed by suicide attempt. The best fitting model had an AUC of 0.826 (95% CI: 0.809-0.843). Conclusions:The MHRN model accurately predicted suicide attempts among AI/AN patients. Future work should develop clinical and operational guidance for effective implementation of the model with this population.

show abstract

Section: Discussionmentioning

confidence: 89%

Validating a predictive algorithm for suicide risk with Alaska Native populations

Shaw

Beans

Noonan

et al. 2022

Suicide & Life Threat Behav

Self Cite

View full text Add to dashboard Cite

show abstract

“…In an effort to create a more elder-friendly health system, leaders at Southcentral Foundation (SCF), a tribally owned and operated healthcare system serving over 65,000 AN/AI people in southcentral Alaska, are developing strategies to improve detection and management of ADRD and associated health events [ 23 ]. In 2017, SCF conducted a study to identify and characterize the service use of individuals with ADRD [ 24 ]. SCF identified a sharp increase in healthcare service use during the year of ADRD diagnosis and a plateau effect for most healthcare services in the years thereafter [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…In 2017, SCF conducted a study to identify and characterize the service use of individuals with ADRD [ 24 ]. SCF identified a sharp increase in healthcare service use during the year of ADRD diagnosis and a plateau effect for most healthcare services in the years thereafter [ 24 ]. The exception was primary care visits, which continued at higher rates compared with people with no ADRD diagnosis [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

“…SCF identified a sharp increase in healthcare service use during the year of ADRD diagnosis and a plateau effect for most healthcare services in the years thereafter [ 24 ]. The exception was primary care visits, which continued at higher rates compared with people with no ADRD diagnosis [ 24 ]. These analyses did not attempt to prospectively identify demographic or clinical factors associated with healthcare service use levels after diagnosis, nor did they evaluate whether differences in post-diagnosis healthcare service use are associated with ADRD prognosis or mortality.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patterns of Healthcare Use and Mortality After Alzheimer’s Disease or Related Dementia Diagnosis Among Alaska Native Patients: Results of a Cluster Analysis in a Tribal Healthcare Setting

Avey

Schaefer

Noonan

et al. 2022

Journal of Alzheimer's Disease Reports

Self Cite

View full text Add to dashboard Cite

Background: Alaska Native and American Indian (AN/AI) people represent a rapidly aging population with disproportionate burdens of Alzheimer’s disease and related dementias (ADRD) risk factors. Objective: To characterize healthcare service use patterns and mortality in the years following ADRD diagnosis for patients in an Alaska Native Tribal health system. Methods: The study sample included all AN/AI patients aged 55 or older with an ADRD diagnosis who were seen between 2012–2018 (n = 407). We used cluster analysis to identify distinct patterns of healthcare use for primary care, emergency and urgent care, inpatient hospital stays, and selected specialty care. We compared demographic and clinical factors between clusters and used regression to compare mortality. Results: We identified five clusters of healthcare service use patterns after ADRD diagnosis: 1) people who use a low amount of all services (n = 107), 2) people who use a high amount of all services (n = 60), 3) people who use a high amount of primary and specialty care (n = 105), 4) people who use a high amount of specialty care (n = 65), and 5) people who use a high amount of emergency and urgent care (n = 70). The cluster with the highest use had the greatest proportion of comorbidities and had a 2.3-fold increased risk of mortality compared to the cluster with the lowest healthcare service use. Conclusion: Results indicate that those receiving the most services had the greatest healthcare-related needs and increased mortality. Future research could isolate factors that predict service use following ADRD diagnosis and identify other differential health risks.

show abstract

“…Their aging, and concomitant risk for Alzheimer's disease and related dementias, pose particular challenges for this historically neglected, under-resourced population (Griffin-Pierce et al, 2008). As of 2018, it is estimated that 5.7 million people in the United States suffer from Alzheimer's disease with an anticipated increase to 14 million by 2050 (Alzheimer's Association, 2018;Herbert et al, 2003;Plassman et al, 2007;Schaefer et al, 2019). The potential compromises of the health status and function of older AI/AN people are obvious, as are the subsequent demands on family and the increased costs to formal, as well as informal, systems of care (DHHS, CMS, 2015).…”

Section: Introductionmentioning

confidence: 99%

The Association of Cultural Participation and Social Engagement With Self-Reported Diagnosis of Memory Problems Among American Indian and Alaska Native Elders

2021

Self Cite

View full text Add to dashboard Cite

Objective: This study examines the association of cultural participation and social engagement with self-reported diagnosis of memory problems among older American Indians and Alaska Natives (AI/ANs). Method: We conducted a cross-sectional study of 14,827 AI/ANs using data from the 2014–2017 cycle of the Identifying Our Needs: A Survey of Elders (ION). Logistic regression was used to examine the association of cultural participation and social engagement with self-reported diagnosis of memory problems. Results: Compared to older AI/ANs who reported high cultural participation and/or high social engagement, those characterized by low cultural participation and/or low social engagement exhibited significantly higher odds of a self-reported diagnosis of memory problems (OR = 1.863, 95% CI: [1.269, 2.734], p = .001). Discussion: Older AI/ANs who described either or both low cultural participation and low social engagement endorsed far more self-reported diagnoses of memory problems, suggesting a strong association that warrants further study for potential causality.

show abstract

Differences in service utilization at an urban tribal health organization before and after Alzheimer's disease or related dementia diagnosis: A cohort study

Cited by 10 publications

References 33 publications

Validating a predictive algorithm for suicide risk with Alaska Native populations

Validating a predictive algorithm for suicide risk with Alaska Native populations

Patterns of Healthcare Use and Mortality After Alzheimer’s Disease or Related Dementia Diagnosis Among Alaska Native Patients: Results of a Cluster Analysis in a Tribal Healthcare Setting

The Association of Cultural Participation and Social Engagement With Self-Reported Diagnosis of Memory Problems Among American Indian and Alaska Native Elders

Contact Info

Product

Resources

About