The Hopkins' Economics of Alzheimer's Disease and Services Center has funded four pilot projects:
Project 1: Case-identification of persons with Alzheimer's Disease and Alzheimer's Disease Related Dementia: A methods study to compare diagnoses in structured and unstructured electronic health record data. Hadi Kharrazi, MD, PhD – Principal Investigator
Alzheimer’s Disease Related Dementia (ADRD) is poorly coded in electronic health records (EHRs). To address this gap, this study aims to assess the reliability of ADRD coding in EHRs, and then compare the value of unstructured EHR data in identifying patients with ADRD. Results of this study can enhance our understanding of EHR’s data value in accurately identifying ADRD patients. Study conclusions may improve the use of EHRs to assess patient eligibility in clinical trials and denominator selection for health services research projects targeting the older adults.
Project 2: Race Differences in Supportive Service Utilization by White and Black Caregivers of Persons with ADRD. Chanee Fabius, PhD, MA – Principal Investigator
The purpose of this project is to determine whether the use of supportive services varies by race for black and white caregivers of persons with Alzheimer’s Disease and Related Dementias (ADRD). Persistent health disparities experienced by Black persons living with dementia (PLWD) likely place an added demand on family and unpaid caregivers. There is limited understanding of supportive services accessed by caregivers of PLWD and how utilization may vary by caregiver and care recipient characteristics, particularly across race groups. More information is needed to address the needs of this growing population, inform the design of relevant and effective programs and practices, and increase the capacity of providers and policymakers to serve diverse groups of people impacted by ADRD. Findings from this pilot will provide important information about the current landscape of support for racially diverse ADRD caregivers and better inform strategies to help persons with ADRD and their family and unpaid caregivers.
Project 3: Quantifying Potentially Avoidable Financial Losses Due to Dementia Lauren Nicholas, PhD – Principal Investigator
Dementia represents a threat to retirement security for patients and families because characteristic brain changes make it difficult to remember routine financial characteristics and alter risk perception, increasing susceptibility to fraud and exploitation. Yet little is known about the prevalence and magnitude of financial losses due to dementia and the potential unmet need for assistance with financial management among persons with Alzheimer’s Disease and Related Dementias (ADRD). With no public and/or private sector policies to protect the financial interests of persons with ADRD, there is an urgent need to understand the magnitude of the issue and develop methods to monitor incidence over time so that effective policies can be developed. This pilot project will collect new survey data to assess the prevalence and magnitude of financial losses associated with cognitive impairment and to assess the demographic characteristics of patients and families affected by these losses.
Project 4: Assessing State Variability in Measures of Dementia Prevalence. Emmanuel Drabo, PhD – Principal Investigator
The purpose of this pilot study is to contribute new and more robust estimates of state-level measures of Alzheimer’s Disease and Related Dementias (ADRD) prevalence and potential variability in prevalence from multiple national datasets (American Community Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, and Medicare Claims) with both self-reported measures and diagnosed ADRD. The evidence generated by this research will directly support Drabo’s planned career development application to NIA around ADRD diagnosis and care burden. The anticipated outcome from this proposed training plan and research agenda is to contribute stronger and more robust information regarding state-level estimates of ADRD prevalence to set the stage for further work to quantify ADRD burden, and to permit dementia-related research in various rich, less restrictive, and relatively user-friendly data sources.
Project 5: Variation in Medicare Home Health Costs Associated with Patient Cognitive Impairment. Julia Burgdorf, PhD – Principal Investigator
Older adults with Alzheimer’s Disease and Related Dementias (ADRD) have uniquely challenging care needs, large comorbidity burdens, and are heavy users of health care; they comprise an estimated one-third of the patient population in Medicare-funded home health care. Current risk-adjustment models for Medicare home health reimbursement fail to account for whether a patient has ADRD. This omission has the potential to threaten access to care for this vulnerable subpopulation. Using linked survey, patient assessment, and claims data, this pilot will provide the first evidence regarding the relationship between patient cognitive impairment and costs of care during Medicare-funded home health care. Findings will offer a better understanding of the resources needed to provide skilled care at home for older adults with ADRD and may inform future revisions to the Medicare home health reimbursement model.