Early identification of persons living with dementia at point‐of‐care hospitalization using the electronic medical record

Abstract

AbstractBackgroundHospitalization for Alzheimer's disease and related dementias (ADRD) is the single largest expense in the U.S., accounting for two thirds of Medicare costs for ADRD estimated at $155 billion in 2020. Persons living with dementia (PLWD) are twice as likely to be hospitalized, have longer average lengths of stay, higher readmission and mortality rates and are at increased risk for institutionalization. A major challenge is the low rates of identification of PLWD upon admission to the hospital, preventing early institution of person‐centered collaborative care interventions that can improve patient outcomes.MethodTwo trained dementia nurse practitioners performed a prospective daily review of all patients age >70 years admitted to a large academic medical center for a period of 8‐weeks (1/26/2021 – 3/23/2021). The NPs performed a systematic keyword search of the EMR for ADRD diagnoses, which were confirmed through review of past medical history, outpatient primary care and consult notes, problem and medication lists. Hospitalized PLWD were analyzed for quality of care indicators.ResultOf the 249 hospitalized patients (mean age 86.5 years;61% female) with ADRD diagnosis, 47 (18%) had dementia included in the admission diagnosis while 151 (61%) had dementia included in the admission history and/or assessment/plan. 71 patients (29%) had restraints ordered, 120 (48%) were prescribed psychoactive medications and 95 (38%) were put on restraints. Advance directives were completed for 122 (49%) of PLWD and 157 (63%) had a full code status. 149 (60%) had a previous inpatient admission and 57 (23%) had an ED visit in the last 12 months. Ninety‐five (38%) of hospitalized PLWD were discharged to institutional facilities.ConclusionThere are low rates of inclusion of dementia in admission diagnoses and notes of hospitalized PLWD. In contrast, there are high rates of restraint use, psychoactive medication order and discharge to institutional facilities. Most PLWD admitted to the hospital has had a previous hospitalization in the past year. To our knowledge, this is the first study that utilized EMR‐based identification of ADRD diagnosis and tracking of hospital outcomes of PLWD. These findings represent opportunities for improvement in quality and outcomes of hospital care for PLWD.