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: Patterns of Use of Low-Value Drugs by Older Adults with ADRD. Emmanuel Drabo, PhD – Principal Investigator
The widespread use of low-value drugs such as antipsychotics in older adults with Alzheimer’s Disease and Related Dementias (ADRD) remains an understudied clinical and public health concern, and a high priority issue for the Centers for Medicare and Medicaid Services and U.S. federal oversight agencies. Reforming reimbursement from paying for services irrespective of value toward rewarding the provision of high-value care has been widely embraced as the pathway for reducing low-value care, and growing evidence supports the effectiveness of these reforms. The fact that the growing Medicare Advantage (MA) program provides incentives for payers to manage care of their beneficiaries, unlike the Traditional Medicare which is still predominately a Fee-for-Service model suggests that MA could potentially reduce the use of low-value drugs in the treatment of ADRD. The purpose of this pilot study is to test the feasibility of a large-scale Medicare claims study of whether MA may reduce the use of potentially low-value drugs in the treatment of ADRD compared to traditional Fee-For-Service Medicare, by leveraging data from the National Health and Aging Trends Study (NHATS), linked to the Medicare claims. The evidence generated by this research will help inform future larger studies on the impact of health care financing policies on outcomes for persons with ADRD and their caregivers and build an evidence base regarding the use of payment as an effective strategy for improving the value of ADRD care.