Reduced Utilization of Health Services for Dementia With Greater Continuity of Care

May 21, 2016

For Medicare beneficiaries with dementia, greater continuity of care (CoC) results in lower costs, lower risk of hospitalization, and less medical testing.

The findings were presented by Halima Amjad, MD, MPH, Johns Hopkins University School of Medicine (Baltimore, MD) at the American Geriatrics Society Annual Meeting (May 19-21, 2016; Long Beach, CA).

Increasing CoC has been shown to decrease hospitalizations, the overuse of medical procedures, and health care costs. For patients with dementia, Dr Amjad said, CoC is even more important, because it allows the care provider, patient, and their family members to build a relationship over time, which enables the care provider to better identify the patient’s needs.

Using Medicare Parts A and B claims from 2012 for a national sample of beneficiaries over the age of 65 years with a diagnosis of dementia, Dr Amjad evaluated the relationship between CoC and utilization and costs of health care services. For each patient, CoC was quantified as an index value on a scale of 0 to 1, taking into account the number of doctor visits, the number of total doctors seen, and the numbers of visits to each doctor. The index value was then converted into a score of low, medium, or high CoC.

Patients with dementia who had higher CoC tended to be slightly older (mean age, 82.3 years vs 79.9 years and 80.9 years for low and medium CoC, respectively); tended to be female; had fewer chronic conditions; and had fewer ambulatory visits.

Compared with patients with low CoC, patients with high CoC had significantly reduced health services utilization: they had 5% fewer hospitalizations, 15% fewer ER visits, 12% fewer CT head scans, 37% fewer urinalyses, and 8% fewer urine cultures.

High CoC was also associated with significantly lower average total spending per beneficiary. For patients with dementia who had high CoC, average total spending per beneficiary was $2367 less than for those with low CoC, resulting from lower hospital and SNF spending (-$1226) as well as lower physician spending (-$1278).

Dr Amjad concluded that greater continuity of physician visits could reduce the use of redundant testing and avoidable hospitalizations, thus optimizing the value of care provided to older adults with dementia.



Amjad H. Continuity of care & healthcare utilization in older adults with dementia. Presented at the American Geriatrics Society Annual Meeting. May 19, 2016. Long Beach, CA.