Affiliation:
1. Department of Family Medicine and Community Health Duke University Durham North Carolina USA
2. Duke University School of Nursing Duke University Durham North Carolina USA
3. Center for the Study of Aging and Human Development Duke University Durham North Carolina USA
4. Department of Population Health Sciences Duke University Durham North Carolina USA
5. Duke Clinical Research Institute Duke University Durham North Carolina USA
6. Department of Sociology Duke University Durham North Carolina USA
Abstract
AbstractBACKGROUNDWe examined the sequences of clinical care leading to diagnoses of Alzheimer's disease and related dementias (ADRD) using electronic health records from a large academic medical center.METHODSWe included patients aged 65+ with their first ADRD diagnoses from January 1, 2014 to December 31, 2019. Using state sequence analysis, care sequences were defined by the ordering of healthcare utilizations occurred in the 2 years before ADRD diagnosis.RESULTSOf 3621 patients (median age 80), nearly half followed a care sequence of having one primary care visit close to their ADRD diagnosis. Additional care sequences included periodic (n = 322, 8.9%) and multiple (n = 416, 11.5%) outpatient visits to primary care and having one (n = 395, 10.9%), multiple (n = 469, 13.0%), or highly frequent (n = 357, 10.7%) outpatient visits to other specialties. Patients’ sociodemographic traits contributed to the variability in care sequences.CONCLUSIONSSeveral distinct patterns of care leading to ADRD diagnoses were identified. Integrated care models are needed to promote early identification of ADRD.Highlights
Dementia patients followed distinct care pathways prior to their dementia diagnoses.
Key sociodemographic traits contributed to the variation in the sequences of care.
Racial differences in the sequencing of care were also found, but only in women.
Funder
National Institute on Aging
National Institute on Minority Health and Health Disparities
Subject
Psychiatry and Mental health,Cellular and Molecular Neuroscience,Geriatrics and Gerontology,Neurology (clinical),Developmental Neuroscience,Health Policy,Epidemiology