Laura O Wray1, Michael Wade2, Gregory P Beehler3, Linda A Hershey4, Christina L Vair5. 1. VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Division of Geriatrics/Gerontology, Department of Medicine, School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, New York. Electronic address: laura.wray@va.gov. 2. VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York. 3. VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York; School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York. 4. Department of Neurology, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma. 5. VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Department of Psychology, University of Colorado, Colorado Springs, Colorado.
Abstract
OBJECTIVE: Alzheimer's disease and related dementias are common and costly, with increased healthcare utilization for patients with these disorders. The current study describes a novel dementia detection program for veterans and examines whether program-eligible patients have higher healthcare utilization than age-matched comparison patients. DESIGN: Using a telephone-based case-finding approach, the detection program used risk factors available in the electronic medical record (EMR) and telephone-based brief cognitive screening. Holding illness severity constant, dementia detection and healthcare utilization were compared across age-matched groups with and without program risk factors. SETTING: Five Veterans Affairs Healthcare Network Upstate New York primary care clinics. PARTICIPANTS: Veterans aged 70 years and older. MEASUREMENTS: EMR data and the Charlson comorbidity index. RESULTS: Program-eligible patients (n = 5,333) demonstrated significantly greater levels of medical comorbidity relative to comparison patients and were on average more than twice as likely to be admitted to the hospital. They also had nearly double the number of outpatient visits to several services. Similar patterns were seen in those who screened positive on a brief cognitive measure, compared with those who screened negative. CONCLUSIONS: A novel program using EMR data to assist in the detection of newly diagnosed dementia in a clinical setting was found to be useful in identifying older veterans with multiple comorbid medical conditions and increased utilization of hospital and clinic services. Results suggest undetected cognitive impairment and dementia may significantly contribute to healthcare utilization and costs of care in older veterans. Published by Elsevier Inc.
OBJECTIVE:Alzheimer's disease and related dementias are common and costly, with increased healthcare utilization for patients with these disorders. The current study describes a novel dementia detection program for veterans and examines whether program-eligible patients have higher healthcare utilization than age-matched comparison patients. DESIGN: Using a telephone-based case-finding approach, the detection program used risk factors available in the electronic medical record (EMR) and telephone-based brief cognitive screening. Holding illness severity constant, dementia detection and healthcare utilization were compared across age-matched groups with and without program risk factors. SETTING: Five Veterans Affairs Healthcare Network Upstate New York primary care clinics. PARTICIPANTS: Veterans aged 70 years and older. MEASUREMENTS: EMR data and the Charlson comorbidity index. RESULTS: Program-eligible patients (n = 5,333) demonstrated significantly greater levels of medical comorbidity relative to comparison patients and were on average more than twice as likely to be admitted to the hospital. They also had nearly double the number of outpatient visits to several services. Similar patterns were seen in those who screened positive on a brief cognitive measure, compared with those who screened negative. CONCLUSIONS: A novel program using EMR data to assist in the detection of newly diagnosed dementia in a clinical setting was found to be useful in identifying older veterans with multiple comorbid medical conditions and increased utilization of hospital and clinic services. Results suggest undetected cognitive impairment and dementia may significantly contribute to healthcare utilization and costs of care in older veterans. Published by Elsevier Inc.
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