A-115 Identifying Factors Related to High Healthcare Utilization in a Group Of Persons with Dementia and their Caregivers

Abstract

Abstract Objective: Identify factors related to high healthcare utilization in dementia patients to determine a high-risk profile and tailor the Care Ecosystem Program to subgroup needs. Methods: Cross-sectional data on persons with dementia (PWD) and caregivers (CG) enrolled in a branch of the Care Ecosystem Program (memory.ucsf.edu/Care-Ecosystem) were used. PWD had one emergency department (ED) visit or hospitalization prior 12-months. Data for 273 dyads included sociodemographics, healthcare utilization, dementia severity (Quick Dementia Rating Scale), and emotional wellbeing (i.e., Short-Form Zarit Burden Interview, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7). High utilizers (HU) were more than two standard deviations above the mean for ED visits (N = 40) or hospitalizations (N = 42). Analyses included descriptive, frequencies, independent sample t-tests, and negative binomial regressions. Results: Mean age was 80 years for PWD and 64 years for CGs. Both were predominantly female (PWD = 60%, CG = 78%) and white (64%) with high school education or higher (PWD = 83.5%, CG = 97.4%). Dementia severity was mild to moderate (QDRS M = 11.4; SD = 6). ED-HU had higher/more dementia severity (p = 0.03, d = 6.2), medical comorbidities (p < 0.001, d = 2.4), medications (p = 0.047, d = 4.5), and preventable (p = 0.013, d = 0.7) and unpreventable (p < 0.001, d = 1.5) visits. Hospitalization HU presented increased neuropsychiatric severity (p = 0.048, d = 6.5) and medications (p = 0.012, d = 4.4). Negative binomial regression model for ED visits (p = 0.025) showed increased comorbidities as the only predictor (p = 0.034), while the model for hospitalizations (p = 0.010) was associated with Black race (p = 0.004), younger PWD (p = 0.033), and more medications (p < 0.001). Conclusions: Increased medical complexity was associated with HU for ED visits and hospitalizations in PWD-CG dyads. Additional research and possible need for variation in care management services are warranted.