Utilization of Low- and High-value Health Care by Individuals with and Without Cognitive Impairment

Overview

Journal Am J Manag Care

Specialty Health Services

Date 2024 Jul 12

PMID 38995830

Authors

Douglas Barthold

Shangqing Jiang

Anirban Basu

Elizabeth A Phelan

Stephen Thielke

Soo Borson

A Mark Fendrick

Affiliations

Soon will be listed here.

Abstract

Objectives: Cognitive impairment and dementia have rising prevalence and impact the health care utilization and lives of older adults. Receipt of low-value (LV) care and underutilization of high-value (HV) care by individuals with these cognitive disorders may have negative consequences for patient health, health system efficiency, and societal welfare. Evidence on health care value among cognitively impaired individuals is limited; we thus ascertained receipt of LV and HV health care in older adults with normal cognition, cognitive impairment without dementia (CIND), and dementia.

Study Design: Retrospective cohort study of Health and Retirement Study data linked to Medicare claims (1996-2018).

Methods: We examined the association between cognitive decline and the receipt of 5 LV and 7 HV services vs individuals with no change in cognition.

Results: Receipt of LV care ranged from 4% to 13% regardless of cognitive status. Cognitive decline (from unimpaired to either CIND or dementia) was associated with decreased probability of receipt of 1 LV service (colorectal cancer screening at 85 years and older [5-percentage-point reduction; P = .047]) and 3 HV services (glucose-lowering drugs [7-percentage-point reduction; P = .029], statins [32-percentage-point reduction; P = .045], and antiresorptive therapy [61-percentage-point reduction; P = .019]).

Conclusions: LV service receipt is wasteful and may be harmful, but it was not consistently associated with cognitive status. Lack of HV care for those with cognitive impairment could be a missed opportunity to improve well-being or reduce preventable adverse events. Our results suggest opportunities for improving the quality of care received by all older adults, including those with cognitive impairment.

References

Zissimopoulos J, Tysinger B, St Clair P, Crimmins E . The Impact of Changes in Population Health and Mortality on Future Prevalence of Alzheimer's Disease and Other Dementias in the United States. J Gerontol B Psychol Sci Soc Sci. 2018; 73(suppl_1):S38-S47. PMC: 6019010. DOI: 10.1093/geronb/gbx147. View

Lee S, Larson E, Dublin S, Walker R, Marcum Z, Barnes D . A Cohort Study of Healthcare Utilization in Older Adults with Undiagnosed Dementia. J Gen Intern Med. 2017; 33(1):13-15. PMC: 5756157. DOI: 10.1007/s11606-017-4162-3. View

Gotanda H, Nuckols T, Mori K, Tsugawa Y . Comparison of the Quality of Chronic Disease Management Between Adults With and Without Dementia. JAMA Netw Open. 2021; 4(5):e219622. PMC: 8120327. DOI: 10.1001/jamanetworkopen.2021.9622. View

Shahzad M, Song Z, Chernew M, Fendrick A . Changes in use of low-value services during the COVID-19 pandemic. Am J Manag Care. 2022; 28(11):600-604. DOI: 10.37765/ajmc.2022.89031. View

Hoffman G, Maust D, Harris M, Ha J, Davis M . Medicare spending associated with a dementia diagnosis among older adults. J Am Geriatr Soc. 2022; 70(9):2592-2601. PMC: 9790668. DOI: 10.1111/jgs.17835. View

Langa K, Levine D . The diagnosis and management of mild cognitive impairment: a clinical review. JAMA. 2014; 312(23):2551-61. PMC: 4269302. DOI: 10.1001/jama.2014.13806. View

Levine D, Langa K, Fagerlin A, Morgenstern L, Nallamothu B, Forman J . Physician decision-making and recommendations for stroke and myocardial infarction treatments in older adults with mild cognitive impairment. PLoS One. 2020; 15(3):e0230446. PMC: 7077853. DOI: 10.1371/journal.pone.0230446. View

Cassel C, Guest J . Choosing wisely: helping physicians and patients make smart decisions about their care. JAMA. 2012; 307(17):1801-2. DOI: 10.1001/jama.2012.476. View

Langa K, Larson E, Crimmins E, Faul J, Levine D, Kabeto M . A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012. JAMA Intern Med. 2016; 177(1):51-58. PMC: 5195883. DOI: 10.1001/jamainternmed.2016.6807. View

10.

Crimmins E, Kim J, Langa K, Weir D . Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study. J Gerontol B Psychol Sci Soc Sci. 2011; 66 Suppl 1:i162-71. PMC: 3165454. DOI: 10.1093/geronb/gbr048. View

11.

Cliff B, Avancena A, Hirth R, Lee S . The Impact of Choosing Wisely Interventions on Low-Value Medical Services: A Systematic Review. Milbank Q. 2021; 99(4):1024-1058. PMC: 8718584. DOI: 10.1111/1468-0009.12531. View

12.

Mafi J, Parchman M . Low-value care: an intractable global problem with no quick fix. BMJ Qual Saf. 2018; 27(5):333-336. PMC: 6727656. DOI: 10.1136/bmjqs-2017-007477. View

13.

Feldman P, Gould D, Levine C, Kuerbis A, Donelan K . The experiences and challenges of informal caregivers: common themes and differences among whites, blacks, and hispanics. Gerontologist. 2001; 41(6):733-41. DOI: 10.1093/geront/41.6.733. View

14.

Sloan F, Trogdon J, Curtis L, Schulman K . The effect of dementia on outcomes and process of care for Medicare beneficiaries admitted with acute myocardial infarction. J Am Geriatr Soc. 2004; 52(2):173-81. DOI: 10.1111/j.1532-5415.2004.52052.x. View

15.

Schwartz A, Landon B, Elshaug A, Chernew M, McWilliams J . Measuring low-value care in Medicare. JAMA Intern Med. 2014; 174(7):1067-76. PMC: 4241845. DOI: 10.1001/jamainternmed.2014.1541. View

16.

. 2022 Alzheimer's disease facts and figures. Alzheimers Dement. 2022; 18(4):700-789. DOI: 10.1002/alz.12638. View

17.

Nicholas L, Langa K, Halpern S, Macis M . How do surrogates make treatment decisions for patients with dementia: An experimental survey study. Health Econ. 2024; 33(6):1211-1228. PMC: 11058026. DOI: 10.1002/hec.4810. View

18.

Oronce C, Fendrick A, Ladapo J, Sarkisian C, Mafi J . The Utilization and Costs of Grade D USPSTF Services in Medicare, 2007-2016. J Gen Intern Med. 2021; 36(12):3711-3718. PMC: 8045442. DOI: 10.1007/s11606-021-06784-8. View

19.

McCormick W, Kukull W, van Belle G, Bowen J, Teri L, Larson E . The effect of diagnosing Alzheimer's disease on frequency of physician visits: a case-control study. J Gen Intern Med. 1995; 10(4):187-93. DOI: 10.1007/BF02600253. View

20.

Levine D, Langa K, Galecki A, Kabeto M, Morgenstern L, Zahuranec D . Mild Cognitive Impairment and Receipt of Treatments for Acute Myocardial Infarction in Older Adults. J Gen Intern Med. 2019; 35(1):28-35. PMC: 6957594. DOI: 10.1007/s11606-019-05155-8. View