Practice Implications of Patterns of Healthcare Utilization before and after Alzheimer’s Disease diagnosis (P2-6.005)

Abstract

<h3>Objective:</h3> To describe patterns of dementia-related healthcare utilization before and after initial diagnosis code for Alzheimer’s Disease (AD). <h3>Background:</h3> Clinical guidelines and common practices indicate appropriate responses to dementia warning signs, for diagnostic work-up and medical management of AD. It is not clear, however, to what extent these practice patterns are followed and what consequences they may have for AD patients. <h3>Design/Methods:</h3> Structured electronic health records from the Department of Veterans Affairs healthcare system (VA), the largest integrated healthcare system in the United States, were examined to identify first recorded AD diagnosis (ICD) code in patients with at least two visits with AD codes. Use of related diagnostic and therapeutic services was compared in the year preceding and following first AD diagnosis. 2018 was studied to limit Covid-19 driven changes in practice. <h3>Results:</h3> A first AD code was found in 2018 for 6,046 patients (mean age of 80.5 years; 97% men). Most (53.1%) had a prior diagnosis code of dementia not-otherwise-specified and 29.4% had a prior code for mild cognitive impairment, with first codes appearing an average of three prior. Services increased from the year before to the year after first AD diagnosis: neuroimaging (31.3% to 32.2%), neuropsychological assessment (25.7% to 32.3%), specialist visit (neurologist, geriatric psychiatrist or geriatrician) (51.1% to 73.2%), prescribed dementia-specific medications (30.2% to 60.5%), inpatient care (11.4% to 25.9%), and home healthcare services (45.8% to 63.6%) (p&lt;0.01 for all except neuroimaging). <h3>Conclusions:</h3> Use of dementia and aging-related services increased after first AD diagnosis code. For many, dementia-targeted treatment began years before AD coding and diagnostic procedures continued afterward. These service and treatment patterns may reflect the complexity of AD diagnostic and care processes in clinical practice, including variability regarding when to attribute dementia to a specific underlying etiology. <b>Disclosure:</b> An immediate family member of Dr. Moo has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Taylor and Francis. Dr. Moo has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Smith Mirabella Blake. Dr. Moo has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Cambridge Medical Experts. The institution of Dr. Moo has received research support from VA HSR&amp;D. The institution of Dr. Moo has received research support from VA Office of Rural Health. The institution of Dr. Davila has received research support from Department of Veterans Affairs. Dr. Jasuja has nothing to disclose. Mrs. Palnati has received personal compensation for serving as an employee of Optum. Mrs. Palnati has received personal compensation in the range of $50,000-$99,999 for serving as a Research Analyst with Veterans Administration. Qing Shao has nothing to disclose. Ms. Dinesh has nothing to disclose. The institution of Dr. Palacios has received research support from Eisai, Inc. The institution of Dr. Palacios has received research support from NIH. The institution of Dr. Palacios has received research support from Department of Veterans Affairs. Dr. Palacios has a non-compensated relationship as a Grant Reviewer with National Institutes of Health that is relevant to AAN interests or activities. Dr. Palacios has a non-compensated relationship as a Associate Editor with Journal of Alzheimer’s Disease that is relevant to AAN interests or activities. Dr. Palacios has a non-compensated relationship as a Researcher with Department of Veterans Affairs that is relevant to AAN interests or activities. Ms. McDannold has nothing to disclose. Weiming Xia has nothing to disclose. Dr. Zhang has received personal compensation for serving as an employee of Eisai. Amir Tahami has received personal compensation for serving as an employee of Eisai. Dr. Miller has nothing to disclose.