A Program to Improve Detection of Undiagnosed Dementia in Primary Care and Its Association with Healthcare Utilization

• Published in: The American journal of geriatric psychiatry 2014-11, Vol.22 (11), p.1282-1291
• Main Authors: Wray, Laura O., Ph.D, Wade, Michael, M.S, Beehler, Gregory P., Ph.D., M.A, Hershey, Linda A., M.D., Ph.D, Vair, Christina L., Ph.D
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Delivery of Health Care - utilization; Dementia - diagnosis; Dementia detection; Electronic Health Records; Female; healthcare utilization; Humans; Internal Medicine; Male; Mass Screening - methods; New York; Primary Health Care - methods; Primary Health Care - standards; primary healthcare; Quality Improvement; Risk Factors; telephone-based case-finding; Veterans - psychology; Veterans - statistics & numerical data; Veterans Health - statistics & numerical data
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2013.04.018

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.