Year: 2006
Type: article
Study design: Observational Study
Abstract: We derived 18 ambulatory care, process quality indicators using evidence–based recommendations from the American Academy of Neurology and the Assessing Care of Vulnerable Elders (ACOVE) project. To examine how often insured patients of an integrated delivery system received recommended dementia care, and to look for evidence of disparities in ambulatory dementia care quality based on age, gender, and race. All patients of the integrated delivery system were identified who had at least one encounter with an ICD–9 code for dementia, were age 50 and older, and who had continuous health plan coverage including prescription drugs for the two years ending January, 2005. We used automated administrative and clinical data, including pharmacy claims, combined with responses from a mailed caregiver's survey to evaluate the 18 process quality indicators. We used generalized estimating equations (GEE) to adjust for clustering effects based upon the provider and to adjust for covariates in multivariable analyses. 351 patients were identified as study eligible, 180 (51%) of which had completed caregiver surveys returned. Patients with surveys differed significantly (p<0.05) from those without on demographic variables, but not on recommended care processes. Recommended care related to dementia diagnosis and psychosocial support occurred in 53% to 80% of patients. Seventy–eight percent of patients had filled a prescription for a cholinesterase inhibitor, but only 34% had evidence of persistent treatment. We did not find significant disparities in ambulatory dementia care quality based upon age or race in multivariable models that adjusted for education, marital status, income, Charleston Co–morbidity Index score, and Dementia Severity Rating Scale score. However, in multivariable models women were significantly (p<0.05) more likely to be dispensed an antidepressant medication, more likely to be dispensed an anti–cholinergic medication, and significantly less likely to have evidence of persistent cholinesterase inhibitor use. There is substantial room for improvement in providing recommended dementia care in the ambulatory care setting. The results of this study, including the disparities identified, can be used to better understand barriers to delivering quality dementia care and to target quality improvement efforts in healthcare systems.
Source: Alzheimer s & Dementia
Institutions: University of Nebraska Medical Center, Henry Ford Health
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W3023386522