Lee A Jennings1, Simon Hollands2, Emmett Keeler2, Neil S Wenger3, David B Reuben4. 1. Reynolds Section of Geriatrics, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA. 2. RAND Health, Santa Monica, California, USA. 3. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, California, USA. 4. Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Abstract
BACKGROUND/ OBJECTIVES: Although nurse practitioner dementia care co-management has been shown to reduce total cost of care for fee-for-service (FFS) Medicare beneficiaries, the reasons for cost savings are unknown. To further understand the impact of dementia co-management on costs, we examined acute care utilization, long-term care admissions, and hospice use of program enrollees as compared with persons with dementia not in the program using FFS and managed Medicare claims data. DESIGN: Quasi-experimental controlled before-and-after comparison. SETTING: Urban academic medical center. PARTICIPANTS: A total of 856 University of California, Los Angeles (UCLA) Alzheimer's and Dementia Care program patients were enrolled between July 1, 2012, and December 31, 2015, and 3,139 similar UCLA patients with dementia not in the program. Comparison patients were identified as having dementia using International Classification of Diseases-9 codes and natural language processing of clinical notes. Coarsened exact matching was used to reduce covariate imbalance between intervention and comparison patients. INTERVENTION: Dementia co-management model using nurse practitioners partnered with primary care providers and community organizations. MEASUREMENTS: Average difference-in-differences per quarter over the 2.5-year intervention period for all-cause hospitalization, emergency department (ED) visits, intensive care unit (ICU) stays, and number of inpatient hospitalization days; admissions to long-term care facilities; and hospice use in the last 6 months of life. RESULTS: Intervention patients had fewer ED visits (odds ratio [OR] = .80; 95% confidence interval [CI] = .66-.97) and shorter hospital length of stay (incident rate ratio = .74; 95% CI = .55-.99). There were no significant differences between groups for hospitalizations or ICU stays. Program participants were less likely to be admitted to a long-term care facility (hazard ratio = .65; 95% CI = .47-.89) and more likely to receive hospice services in the last 6 months of life (adjusted OR = 1.64; 95% CI = 1.13-2.37). CONCLUSION: Comprehensive nurse practitioner dementia care co-management reduced ED visits, shortened hospital length of stay, increased hospice use, and delayed admission to long-term care.
BACKGROUND/ OBJECTIVES: Although nurse practitioner dementia care co-management has been shown to reduce total cost of care for fee-for-service (FFS) Medicare beneficiaries, the reasons for cost savings are unknown. To further understand the impact of dementia co-management on costs, we examined acute care utilization, long-term care admissions, and hospice use of program enrollees as compared with persons with dementia not in the program using FFS and managed Medicare claims data. DESIGN: Quasi-experimental controlled before-and-after comparison. SETTING: Urban academic medical center. PARTICIPANTS: A total of 856 University of California, Los Angeles (UCLA) Alzheimer's and Dementia Care program patients were enrolled between July 1, 2012, and December 31, 2015, and 3,139 similar UCLA patients with dementia not in the program. Comparison patients were identified as having dementia using International Classification of Diseases-9 codes and natural language processing of clinical notes. Coarsened exact matching was used to reduce covariate imbalance between intervention and comparison patients. INTERVENTION: Dementia co-management model using nurse practitioners partnered with primary care providers and community organizations. MEASUREMENTS: Average difference-in-differences per quarter over the 2.5-year intervention period for all-cause hospitalization, emergency department (ED) visits, intensive care unit (ICU) stays, and number of inpatient hospitalization days; admissions to long-term care facilities; and hospice use in the last 6 months of life. RESULTS: Intervention patients had fewer ED visits (odds ratio [OR] = .80; 95% confidence interval [CI] = .66-.97) and shorter hospital length of stay (incident rate ratio = .74; 95% CI = .55-.99). There were no significant differences between groups for hospitalizations or ICU stays. Program participants were less likely to be admitted to a long-term care facility (hazard ratio = .65; 95% CI = .47-.89) and more likely to receive hospice services in the last 6 months of life (adjusted OR = 1.64; 95% CI = 1.13-2.37). CONCLUSION: Comprehensive nurse practitioner dementia care co-management reduced ED visits, shortened hospital length of stay, increased hospice use, and delayed admission to long-term care.
Authors: David B Reuben; Leslie Chang Evertson; Rebecca Jackson-Stoeckle; Gary Epstein-Lubow; Lynn Hill Spragens; Kristin Lees Haggerty; Katherine Sy Serrano; Lee A Jennings Journal: J Am Geriatr Soc Date: 2022-06-09 Impact factor: 7.538
Authors: Kristin Lees Haggerty; Randi Campetti; Rebecca Jackson Stoeckle; Gary Epstein-Lubow; Leslie Chang Evertson; Lynn Spragens; Katherine Sy Serrano; Lee A Jennings; David B Reuben Journal: J Am Geriatr Soc Date: 2022-05-25 Impact factor: 7.538
Authors: Matthew K McNabney; Ariel R Green; Meg Burke; Stephanie T Le; Dawn Butler; Audrey K Chun; David P Elliott; Ana Tuya Fulton; Kathryn Hyer; Belinda Setters; Joseph W Shega Journal: J Am Geriatr Soc Date: 2022-04-29 Impact factor: 7.538