Mia Yang1, Chiang-Hua Chang2, Donald Carmichael2, Esther S Oh3, Julie P W Bynum4. 1. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. 2. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. 3. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD. 4. The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH. Electronic address: Julie.PW.Bynum@dartmouth.edu.
Abstract
OBJECTIVES: To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings. DESIGN: Cross-sectional analysis. PARTICIPANTS: Fee-for-service Medicare beneficiaries aged ≥65 years with dementia. MEASUREMENTS: Specialty, categorized into primary care (internal or family medicine, geriatrics, or nurse practitioners [NPs]) versus other specialties, of the predominant provider of care (PPC) for each patient, defined by providing the most ambulatory visits. RESULTS: Among 2,598,719 beneficiaries with dementia, 74% lived in the community and 80% had a PPC in primary care. In LTC, 91% had primary care as their PPC compared with 77% in the community (P < .001). Cardiology and neurology were the most frequent specialties. NPs were PPCs for 19% of dementia patients in LTC versus 7% in the community (P < .001). CONCLUSION: It is unknown whether specialists are aware of their central role for many dementia patients' care needs. In LTC, NPs play the lead role as PPCs.
OBJECTIVES: To identify which clinical specialties are most central for care of people with dementia in the community and long-term care (LTC) settings. DESIGN: Cross-sectional analysis. PARTICIPANTS: Fee-for-service Medicare beneficiaries aged ≥65 years with dementia. MEASUREMENTS: Specialty, categorized into primary care (internal or family medicine, geriatrics, or nurse practitioners [NPs]) versus other specialties, of the predominant provider of care (PPC) for each patient, defined by providing the most ambulatory visits. RESULTS: Among 2,598,719 beneficiaries with dementia, 74% lived in the community and 80% had a PPC in primary care. In LTC, 91% had primary care as their PPC compared with 77% in the community (P < .001). Cardiology and neurology were the most frequent specialties. NPs were PPCs for 19% of dementiapatients in LTC versus 7% in the community (P < .001). CONCLUSION: It is unknown whether specialists are aware of their central role for many dementiapatients' care needs. In LTC, NPs play the lead role as PPCs.
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