Exploring hospital-based health information technology functions for patients with Alzheimer's Disease and related Dementias

Telehealth Infrastructure, Accountable Care Organization, and Medicare Payment for Patients with Alzheimer's Disease and Related Dementia Living in Socially Vulnerable Areas

Background: Structural social determinants of health have an accumulated negative impact on physical and mental health. Evidence is needed to understand whether emerging health information technology and innovative payment models can help address such structural social determinants for patients with complex health needs, such as Alzheimer's disease and related dementias (ADRD). Objective: This study aimed to test whether telehealth for care coordination and Accountable Care Organization (ACO) enrollment for residents in the most disadvantaged areas, particularly those with ADRD, was associated with reduced Medicare payment. Methods: The study used the merged data set of 2020 Centers for Medicare and Medicaid Services Medicare inpatient claims data, the Medicare Beneficiary Summary File, the Medicare Shared Savings Program ACO, the Center for Medicare and Medicaid Service's Social Vulnerability Index (SVI), and the American Hospital Annual Survey. Our study focused on community-dwelling Medicare fee-for-service beneficiaries aged 65 years and up. Cross-sectional analyses and generalized linear models (GLM) were implemented. Analyses were implemented from November 2023 to February 2024. Results: Medicare fee-for-service beneficiaries residing in SVI Q4 (i.e., the most vulnerable areas) reported significantly higher total Medicare costs and were least likely to be treated in hospitals that provided telehealth post-discharge services or have ACO affiliation. Meanwhile, the proportion of the population with ADRD was the highest in SVI Q4 compared with other SVI levels. The GLM regression results showed that hospital telehealth post-discharge infrastructure, patient ACO affiliation, SVI Q4, and ADRD were significantly associated with higher Medicare payments. However, coefficients of interaction terms among these factors were significantly negative. For example, the average interaction effect of telehealth post-discharge and ACO, SVI Q4, and ADRD on Medicare payment was -$1,766.2 (95% confidence interval: -$2,576.4 to -$976). Conclusions: Our results suggested that the combination of telehealth post-discharge and ACO financial incentives that promote care coordination is promising to reduce the Medicare cost burden among patients with ADRD living in socially vulnerable areas.

Preventable Emergency Department Visits of Patients with Alzheimer's Disease and Related Dementias During the COVID-19 Pandemic by Hospital-Based Health Information Exchange

Background: This study examined the relationship between hospital-based electronic health information exchange (HIE) and the likelihood of having a preventable emergency department (ED) visit during the COVID-19 pandemic for US patients with Alzheimer's Disease and Related Dementias (ADRD). Methods: We used multi-level data from six states. The linked data sets included the 2020 State Emergency Department Databases (SEDD), the Area Health Resources File, the American Hospital Association (AHA) Annual Survey, and the AHA Information Technology Supplement to study 85,261 hospital discharges from patients with ADRD. Logistic regression models were produced to determine the odds of having a preventable ED visit among patients with ADRD. Results: Our final sample included 85,261 hospital discharges from patients with ADRD. Patients treated in hospitals that received more types of clinical information for treating patients with COVID-19 from outside providers (OR = 0.961, p < .05) and/or hospitals that received COVID-19 test results from more outside entities were significantly less likely to encounter preventable EDs (OR = 0.964, p < .05), especially among patients who also had multiple chronic conditions (MCC) (OR = 0.89, p = .001; OR = 0.856, p < .001). Conclusion: Our results suggest that electronic HIE may be useful for reducing preventable ED visits during the COVID-19 pandemic for people with ADRD and ADRD alongside MCC.

Hospital-based Health Information Technology Infrastructure: Evidence of Reduced Medicare Payments and Racial Disparities Among Patients With ADRD

BACKGROUND

Alzheimer disease and related dementia (ADRD) is one of the most expensive health conditions in the United States. Understanding the potential cost-savings or cost-enhancements of Health Information Technology (HIT) can help policymakers understand the capacity of HIT investment to promote population health and health equity for patients with ADRD.

OBJECTIVES

This study examined access to hospital-based HIT infrastructure and its association with racial and ethnic disparities in Medicare payments for patients with ADRD.

RESEARCH DESIGN

We used the 2017 Medicare Beneficiary Summary File, inpatient claims, and the American Hospital Association Annual Survey. Our study focused on community-dwelling Medicare fee-for-service beneficiaries who were diagnosed with ADRD. Our study focused on hospital-based telehealth-postdischarge (eg, remote patient monitoring) and telehealth-treatment (eg, psychiatric and addiction treatment) services.

RESULTS

Results showed that hospital-based telehealth postdischarge services were associated with significantly higher total Medicare payment and acute inpatient Medicare payment per person per year among patients with ADRD on average. The associations between hospital-based telehealth-treatment services and payments were not significant. However, the association varied by patient's race and ethnicity. The reductions of the payments associated with telehealth postdischarge and treatment services were more pronounced among Black patients with ADRD. Telehealth-treatment services were associated with significant payment reductions among Hispanic patients with ADRD.

CONCLUSION

Results showed that having hospital-based telehealth services might be cost-enhancing at the population level but cost-saving for Black and Hispanic patients with ADRD. Results suggested that personalized HIT services might be necessary to reduce the cost associated with ADRD treatment for racial and ethnic minority groups.

An HIT-Supported Care Coordination Framework for Reducing Structural Racism and Discrimination for Patients With ADRD

Black and Latinx Americans are disproportionately at greater risk for having Alzheimer's disease and related dementias (ADRD) than White Americans. Such differences in risk for ADRD are arguably explained through health disparities, social inequities, and historical policies. Structural racism and discrimination (SRD), defined as "macro-level conditions that limit opportunities, resources, and well-being of less privileged groups," have been linked with common comorbidities of ADRD, including hypertension, obesity, diabetes, depression. Given the historical impact of SRD-including discriminatory housing policies resulting in racial residential segregation that has been shown to limit access to education, employment, and healthcare-Black and Latinx populations with ADRD are directly or indirectly negatively affected by SRD in terms of access, quality and cost for healthcare. Emerging studies have brought to light the value of structural-level hospital and public health collaboration on care coordination for improving healthcare quality and access, and thus could serve as a macro-level mechanism for addressing disparities for minoritized racial and ethnic populations with ADRD. This paper presents a conceptual framework delineating how care coordination can successfully be achieved through health information technology (HIT) systems and ultimately address SRD. To address health inequities, it is therefore critical that policy initiatives invest in HIT capacities and infrastructures to promote care coordination, identify patient needs and preferences, and promote engagement of patients with ADRD and their caregivers.