Low continuity of care for older adults with dementia associated with high health care utilization

Older adults with dementia who were Medicare beneficiaries experienced higher rates of ED visits and hospitalizations in correlation with decreased continuity of care, according to research presented at the annual American Geriatrics Society meeting.

A focus on improving continuity of care may improve both the health care system and patient care, Halima Amjad, MD, MPH, a fellow in the Johns Hopkins University School of Medicine's Division of Geriatric Medicine and Gerontology, and colleagues reported.

"Though lower continuity of care is associated with increased hospitalization, overuse of medical procedures, and health care costs in some populations, ambulatory care remains fragmented," they wrote. "In order to build relationships, address goals of care, understand baseline cognition, and appropriately manage acute and chronic conditions, continuity of care may be particularly important for older adults with dementia."

The researchers evaluated 1,416,369 Medicare beneficiaries aged 65 years and older using the national fee-for-service Medicare file. These beneficiaries all had dementia diagnoses and at least four ambulatory visits in 2012, and survived through the year.

Results showed that nearly 50% of the beneficiaries had at least one hospitalization and one ED visit in 2012. Those with lower continuity of care had more comorbidities, higher income and were younger.

In a comparison of the highest and lowest continuity of care groups, there was a difference in health care spending: $22,004 vs. $24,371 per beneficiary, respectively.

In addition, as continuity of care increased, the researchers noted that health care utilization decreased.

"Among fee-for-service Medicare beneficiaries over age 65 with dementia, lower continuity of care is associated with higher rates of hospitalization, ED visits, testing, and spending," Amjad and colleagues concluded. "Improving continuity of care in this population may be beneficial for individual patients and the wider health system." – by Chelsea Frajerman Pardes

Reference:

Amjad H, et al. Continuity of care and healthcare utilization in older adults with dementia. Presented at: American Geriatrics Society 2016 Annual Scientific Meeting; May 19-21; Long Beach, Calif.

Disclosures: The study was supported by the John A. Hartford Foundation. Amjad reports support from HRSA grant D01HP08789 and the Pearl M. Stetler Research Fund.