Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer’s disease and related dementias

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

doi:10.1371/journal.pone.0227681

Cited by 17 publications

(13 citation statements)

References 62 publications

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“…All models included a year fixed-effect. Following prior studies that have used these data [25,33], we did not use sampling weights in this analysis. All analyses were conducted using SAS v. 9.4 (SAS Inc., Cary, NC).…”

Section: Plos Onementioning

confidence: 99%

Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries

et al. 2022

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Objectives To examine Medicare health care spending and health services utilization among high-need population segments in older Mexican Americans, and to examine the association of frailty on health care spending and utilization. Methods Retrospective cohort study of the innovative linkage of Medicare data with the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) were used. There were 863 participants, which contributed 1,629 person years of information. Frailty, cognition, and social risk factors were identified from the H-EPESE, and chronic conditions were identified from the Medicare file. The Cost and Use file was used to calculate four categories of Medicare spending on: hospital services, physician services, post-acute care services, and other services. Generalized estimating equations (GEE) with a log link gamma distribution and first order autoregressive, correlation matrix was used to estimate cost ratios (CR) of population segments, and GEE with a logit link binomial distribution was applied to estimate odds ratios (OR) of healthcare use. Results Participants in the major complex chronic illness segment who were also pre-frail or frail had higher total costs and utilization compared to the healthy segment. The CR for total Medicare spending was 3.05 (95% CI, 2.48–3.75). Similarly, this group had higher odds of being classified in the high-cost category 5.86 (95% CI, 3.35–10.25), nursing home care utilization 11.32 (95% CI, 3.88–33.02), hospitalizations 4.12 (95% CI, 2.88–5.90) and emergency room admissions 4.24 (95% CI, 3.04–5.91). Discussion Our findings highlight that frailty assessment is an important consideration when identifying high-need and high-cost patients.

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Section: Plos Onementioning

confidence: 99%

Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries

et al. 2022

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“…With some exceptions (6,(13)(14)(15), research on health care utilization trends among older adults with and without ADRD is based on data from predominately non-Hispanic White cohorts. Nearly 10% of adults aged 65 and older in the United States are Hispanic (16).…”

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

Downer

Snih

Chou

et al. 2020

The Journals of Gerontology: Series A

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Background Evidence from predominantly non-Hispanic White cohorts indicates healthcare utilization increases before Alzheimer’s disease and related dementias (ADRD) is diagnosed. We investigated trends in healthcare utilization by Mexican-American Medicare beneficiaries before and after an incident diagnosis of ADRD. Methods Data came from the Hispanic Established Populations for the Epidemiologic Study of the Elderly that has been linked with Medicare claims files from 1999-2016 (n=558 matched cases and controls). Piecewise regression and generalized linear mixed models were used to compare the quarterly trends in any (i.e., one or more) hospitalizations, emergency room (ER) admissions, and physician visits for one year before and one year after ADRD diagnosis. Results The piecewise regression models showed that the per-quarter odds for any hospitalizations (OR=1.62, 95% CI=1.43-1.84) and any ER admissions (OR=1.40, 95% CI=1.27-1.54) increased before ADRD was diagnosed. Compared to participants without ADRD, the percentage of participants with ADRD who experienced any hospitalizations (27.2% vs 14.0%) and any ER admissions (19.0% vs 11.7%) was significantly higher at one-quarter and three-quarters before ADRD diagnosis, respectively. The per-quarter odds for any hospitalizations (OR=0.88, 95% CI=0.80-0.97) and any ER admissions (OR=0.89, 95% CI=0.82-0.97) decreased after ADRD was diagnosed. Trends for any physician visits before or after ADRD diagnosis were not statistically significant. Conclusions Older Mexican-Americans show an increase in hospitalizations and ER admissions before ADRD is diagnosed, which is followed by a decrease after ADRD diagnosis. These findings support the importance of a timely diagnosis of ADRD for older Mexican-Americans.

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“…11 Studies show that the usage of certain health services is greater among persons with dementia than persons without dementia. For example, people with dementia are more likely to be hospitalised [12][13][14][15][16][17][18][19][20] and admitted to emergency departments than people without dementia. 15 16 18 19 Reports also show more frequent use of certain services among people with dementia, including family physicians (FPs) [21][22][23][24] and hospital admission.…”

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confidence: 99%

Health service use before and after dementia diagnosis: a retrospective matched case–control study

Kosteniuk

Osman

Osman³

et al. 2022

BMJ Open

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ObjectivesThis study investigated patterns in health service usage among older adults with dementia and matched controls over a 10-year span from 5 years before until 5 years after diagnosis.DesignPopulation-based retrospective matched case–control study.SettingAdministrative health data of individuals in Saskatchewan, Canada from 1 April 2008 to 31 March 2019.ParticipantsThe study included 2024 adults aged 65 years and older living in the community at the time of dementia diagnosis from 1 April 2013 to 31 March 2014, matched 1:1 to individuals without a dementia diagnosis on age group, sex, rural versus urban residence, geographical region and comorbidity.Outcome measuresFor each 5-year period before and after diagnosis, we examined usage of health services each year including family physician (FP) visits, specialist visits, hospital admissions, all-type prescription drug dispensations and short-term care admissions. We used negative binomial regression to estimate the effect of dementia on yearly average health service utilisation adjusting for sex, age group, rural versus urban residence, geographical region, 1 year prior health service use and comorbidity.ResultsAdjusted findings demonstrated that 5 years before diagnosis, usage of all health services except hospitalisation was lower among persons with dementia than persons without dementia (all p<0.001). After this point, differences in higher health service usage among persons with dementia compared to without dementia were greatest in the year before and year after diagnosis. In the year before diagnosis, specialist visits were 59.7% higher (p<0.001) and hospitalisations 90.5% higher (p<0.001). In the year after diagnosis, FP visits were 70.0% higher (p<0.001) and all-type drug prescriptions 29.1% higher (p<0.001).ConclusionsFindings suggest the year before and year after diagnosis offer multiple opportunities to implement quality supports. FPs are integral to dementia care and require effective resources to properly serve this population.

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Healthcare utilization of Mexican-American Medicare beneficiaries with and without Alzheimer’s disease and related dementias

Cited by 17 publications

References 62 publications

Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries

Healthcare utilization and costs among high-need and frail Mexican American Medicare beneficiaries

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

Health service use before and after dementia diagnosis: a retrospective matched case–control study

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