Abstract

?PROJECT1 ThepopulationofAmericanswithAlzheimer?sDiseaseandrelateddementia(ADRD)isexpectedtotripleby 2050.Thereisgreathopefornewtreatmentoptions,butcurrentlywearelimitedtomanagingestablished diseaseandavoidingfurthernegativeoutcomes.Whilenobreakthroughtreatmentshaveemerged,thelast20 yearshaveseenlargechangesinthediagnosisandmanagementofADRDwiththeintroductionofthefirst symptomaticdrugsandadvanceddiagnostictechnologies,suchasamyloidpositronemissiontomography (PET)scanningandcerebrospinalfluidbiomarkers.Whetherearlydiagnosisishelpfulisunknownand controversial,asevidencedbynationalguidelinesthatdisagreeonwhethertoscreenforADRD.Themixed messageslikelycontributetowidedifferencesinobservedstate-specificprevalenceofclinicallydiagnosed ADRDfromwhatwouldbeexpectedbasedonepidemiologicalestimates,rangingfrom30%belowto10% abovetheexpectedprevalence.Suchdifferencesinascertainmentofdiseasesuggestthattheprocessof gettingaclinicaldiagnosisofADRDvariesacrosshealthsystems.Usingthisvariationacrosshealthsystems andchangesovertime,weproposetogaininsightsintohowdiagnosticintensityandearlydiagnosisrelateto clinicaloutcomesofhospitalization,pharmaceuticaluse,andend-of-lifecareamongelderlypopulationsinthe U.S.WewillusenationalMedicareadministrativedatalinkedtonursinghomedata,theHealth&Retirement Studyfrom1996-2018andtheNurse?sHealthStudyfrom1995-2018.Ourunderlyinghypothesisisthatin someregions,peoplearebothmorelikelytoreceiveadiagnosisofADRDandmorelikelytobediagnosed early.Wewillusethesequasi-experimentalvariationsintheextentandtimingofdiagnosisacrossregionsand overtimetoassessthevalueofearlydiagnosisonsubsequenttreatmentsandclinicaloutcomes.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Program Projects (P01)
Project #
5P01AG019783-18
Application #
9884546
Study Section
Special Emphasis Panel (ZAG1)
Project Start
Project End
Budget Start
2020-03-01
Budget End
2021-02-28
Support Year
18
Fiscal Year
2020
Total Cost
Indirect Cost

  Institution

Name
Dartmouth College
Department
Type
DUNS #
041027822
City
Hanover
State
NH
Country
United States
Zip Code
03755

  Publications

Ouayogodé, Mariétou H; Meara, Ellen; Chang, Chiang-Hua et al. (2018) Forgotten patients: ACO attribution omits those with low service use and the dying. Am J Manag Care 24:e207-e215
Rosenthal, Meredith B; Colla, Carrie H; Morden, Nancy E et al. (2018) Overuse and insurance plan type in a privately insured population. Am J Manag Care 24:140-146
Bekelis, Kimon; Missios, Symeon; Coy, Shannon et al. (2018) Emergency medical services for acute ischemic stroke: Hub-and-spoke model versus exclusive care in comprehensive centers. J Clin Neurosci :
Chen, Lena M; Ryan, Andrew M; Shih, Terry et al. (2018) Medicare's Acute Care Episode Demonstration: Effects of Bundled Payments on Costs and Quality of Surgical Care. Health Serv Res 53:632-648
Moen, Erika L; Bynum, Julie P; Austin, Andrea M et al. (2018) Assessing Variation in Implantable Cardioverter Defibrillator Therapy Guideline Adherence With Physician and Hospital Patient-sharing Networks. Med Care 56:350-357
Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A (2018) Outcomes of Elective Cerebral Aneurysm Treatment Performed by Attending Neurosurgeons after Night Work. Neurosurgery 82:329-334
Jeffery, Molly Moore; Hooten, W Michael; Henk, Henry J et al. (2018) Trends in opioid use in commercially insured and Medicare Advantage populations in 2007-16: retrospective cohort study. BMJ 362:k2833
Jeffery, Molly Moore; Hooten, W Michael; Hess, Erik P et al. (2018) Opioid Prescribing for Opioid-Naive Patients in Emergency Departments and Other Settings: Characteristics of Prescriptions and Association With Long-Term Use. Ann Emerg Med 71:326-336.e19
Finkelstein, Amy; Ji, Yunan; Mahoney, Neale et al. (2018) Mandatory Medicare Bundled Payment Program for Lower Extremity Joint Replacement and Discharge to Institutional Postacute Care: Interim Analysis of the First Year of a 5-Year Randomized Trial. JAMA 320:892-900
Bekelis, Kimon; Missios, Symeon; MacKenzie, Todd A (2018) Correlation of hospital magnet status with the quality of physicians performing neurosurgical procedures in New York State. Br J Neurosurg 32:13-17

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