Our Research Projects
Our Center nurtures and supports population-based research that identifies, quantifies, and addresses economic and care systems challenges posed by Alzheimer’s disease and related dementias (ADRD).
About Our Work
Research Aims
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To generate new knowledge about ADRD care in our thematic areas of focus
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To advance the field of ADRD economics and health services research and its impact by nurturing emerging and established investigators, developing a cutting-edge research infrastructure, disseminating new knowledge, and forging linkages with policy and practice communities
Research Themes
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Identifying and quantifying the range of ADRD care needs and related economic consequences
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Examining how the organization and financing of services affects accessibility, affordability, quality, and equity of ADRD care
Racial disparities and caregiving are cross-cutting areas of interest to each theme
2024 Research Projects
Patient-Driven Grouping Model and Home Healthcare Use among Traditional Medicare Beneficiaries With and Without Alzheimer's Disease and Related Dementias
This pilot project aims to compare the intensity of annual use of home health services among people with and without ADRD between the pre-policy period (2017) and the post-policy period (2021) after implementing the patient-driven grouping model for the home health payment system. Specific project-related activities will include submitting IRB approval (should it be funded), creating analytic data files, conducting analysis, and preparing abstracts and manuscripts for conference submission and publication under the mentorship of Dr. Van Houtven. In addition, Dr. Basu will have access to in-house biostatistical consultation within her department, if needed, while creating analytic data files using SAS.
As a PI, Dr. Basu will lead the research in planning, implementing, and coordinating activities to ensure that project objectives and deliverables are met on time. She will consult with her mentor, Dr. Van Houtven, in project-related activities. Dr Basu will be responsible for the timely completion of project-related activities, including IRB approval, ensuring compliance with the IRB for data storage and data security issues for accessing CMS data through the HEADS center. Dr. Basu will create analytical data files, perform the descriptive analysis, and interpret the results. Dr. Basu will meet Dr. Van Houtven as needed to discuss the cohort selection using the propensity score weighting, analytic plan, and results interpretation. Finally, Dr. Basu will prepare the abstract and manuscripts for publication collaboratively with her mentor, Dr. Van Houtven.
Dr. Basu will also plan to present the research findings at the 2025 AcademyHealth Conference, and the travel expense will be covered by the budget from this pilot grant in the amount of $1,441.
Primary Care Delivery Organization and Health Care Use and Quality Among Older Adults with Alzheimer’s Disease and Related Dementias in Traditional Medicare and Medicare Advantage
Co-Investigator: Kun Li, Postdoctoral Associate, Duke University
Consultants: Justin W. Timbie, Senior Health Policy Researcher, RAND Corporation
The study will examine the impact of type of primary care delivery organizations on access to specialty care and quality of care among traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries with Alzheimer’s Disease and Related Dementia (ADRD). We will examine three models of physician organization (POs): federally qualified health centers (FQHCs), single-specialty POs, and multi-specialty POs, which are likely to differ in delivery of services with implications for quality of dementia care. Specific aims include:
1. Identify trends in the setting in which community-based TM and MA beneficiaries with ADRD receive primary care. We will identify the trends in share of community-based Medicare beneficiaries receiving primary care in each setting by MA enrollment over time.
2. Examine the impact of PO delivery models on access to specialty care and quality of care among TM and MA beneficiaries with ADRD. Using an instrumental variable approach, we focus on comparing outcomes of beneficiaries whose usual source of care is an FQHC versus comparable beneficiaries whose usual source of care is a non-FQHC PO, and testing whether the effect of FQHCs is larger in TM than MA. Outcomes include: 1) having neurology or geriatrics visits; 2) all-cause and preventable hospitalization.
Use of Self-funded Paid Care Across the Financial Resource Spectrum Among People With and Without Dementia. Jennifer M. Reckrey, MD- Principal Investigator
Co-Investigators: Karen Shen, PhD, Katherine Ornstein, PhD, and Regina Shih, PhD
As the locus of long-term care shifts from institutions like nursing homes into the home and community, a growing number of older adults with dementia and functional impairment rely on paid caregivers (i.e., home health aides, personal care attendants, and other home care workers) to remain living at home.1-3 While Medicaid is the primary government payer for this care, access to and quantity of Medicaid-funded care varies by financial resources and state policies.4 Therefore, individuals and families across the financial resource spectrum—even low and middle-resource individuals— frequently self-fund (i.e., pay directly from personal or family income or savings) some or all of the paid care they rely on to live in the community.2,5 While this self funded paid care may fill an important need, it may also pose substantial financial burden to people receiving care and their families.6 This impact may be greatest among people with dementia, who require higher levels of care for longer periods of time and are known to have higher out-of-pocket spending as compared to people without dementia.7-9 However, the prevalence and impact of self-funded paid care among people with and without dementia throughout the financial resource spectrum (including those who also receive Medicaid funded care) has not been described. This pilot uses data from the Health and Retirement Study to:
1. Describe the prevalence and financial burden of self-funded paid care across the financial resource spectrum and among people with and without dementia. H1: The financial burden of self-funded paid care will be greater among 1) low and middle-resource(versus high-resource) individuals without Medicaid, and 2) people with dementia (versus people without dementia) regardless of financial resources.
2. Among people with and without dementia across the financial resource spectrum, describe patterns of Medicaid enrollment and paid care use (Medicaid-funded paid care, self-funded paid care, both) and individual/family factors that contribute to these patterns. H1: A significant proportion of Medicaid beneficiaries will supplement Medicaid-funded paid care with self-funded paid care; supplementation will be more common among those with dementia. H2: High-resource people will use self-funded paid care regardless of family support; low and middle-resource people will be more likely to use self-funded paid care when family support is minimal.
3. Among Medicaid enrollees, examine the association of state Medicaid policies with use of selffunded paid care. H1: Those living in states with greater “breadth” of Medicaid coverage will be less likely to use self-funded paid care and those living in states with greater “depth” of Medicaid coverage will be less likely to supplement Medicaid-funded care, an effect more pronounced among people with dementia.
Impact of Social Determinants of Health on Delirium and Dementia. Mfon Umoh, MD, PhD - Principal Investigator
Collaborators: Charles H. Brown IV, MD, Johns Hopkins University School of Medicine, Emmanuel Garcia Morales, PhD, Johns Hopkins University Bloomberg School of Public Health
AIM 1: Characterize the association of SDOH with risk of delirium using medical claims records across four US populations while adjusting for other known risk factors for delirium.
AIM 2A: Examine whether SDOH modifies the association between incident delirium during hospitalization and cognitive decline post-hospitalization. AIM 2B: Explore whether SDOH modifies the association between incident delirium during hospitalization and incident dementia post-hospitalization.
Understanding the role of SDOH in delirium risk and how they may modify the association between delirium and dementia can contribute to developing targeted individual and community interventions to reduce delirium and associated cognitive decline. Conceptually, SDOH may serve as both a predisposing risk factor for delirium as well as a modifier that increases likelihood or severity of negative outcomes (e.g., cognitive decline) among adults who experience delirium. Delirium is prevalent in hospital populations and post operatively, it is associated with significant mortality.15 Cumulative costs attributable to delirium are soaring,16 prior work has estimated the burden of delirium on the health care system to range from $38 billion to $152 billion annually.17 Worldwide, the prevalence of AD and ADRD is projected to triple to more than 150 million people by 2050.18Responding to this requires an improved understanding of both the biological underpinnings of these conditions and the social and contextual factors that magnify the risk of AD and ADRD.
Contextual Factors in Aging Working Group
A joint working group co-sponsored by the Roger and Flo Lipitz Center to Advance Policy in Aging and Disability, the HEADS Center and the Center for Equity in Aging. This group promotes collaboration and improved access to data resources among researchers examining contextual data relevant to aging, including long term services and supports (LTSS), direct care workforce, and neighborhood-level indices.
- When: First Thursday of the month 12-1pm, hybrid format; subgroups have additional meetings
Contact: Danielle Peereboom dpeereb2@jhu.edu
Learn About Our Pilot Grants
Each year, we offer a number of one-year pilot grants ranging from $25,000 to $50,000 to fund research projects that advance our mission.
HEADS Remote Data Enclave
The HEADS Remote Data Enclave Core (RDEC) is the “lab” for the HEADS Center, supporting access to ADRD-relevant datasets in various locations. It also includes its own high-capacity computing environment known as the Health Analytics Research Platform (HARP), offering secure and remote access. The HARP provides data services to HEADS-affiliated and HBHI-affiliated investigators to facilitate cross-university research collaborations advancing HEADS’ aims and HBHI’s strategic pillars. Learn More
Past Research Projects
2023 Smart Rep: Smart Automation to REspond to Patient portal messages. Kelly Gleason, PhD, RN- Principal Investigator
Co-investigators: Roy Adams, PhD
Care partners, unpaid family or friends who partner with patients to manage care, are at the forefront of Alzheimer’s disease and related dementias care. Yet, care partners often go unidentified and unsupported by healthcare systems, which compounds the demands of Alzheimer’s disease and related dementias on patients, clinicians, and care partners. In response to this need, we will develop and test “Smart Rep”, Smart Automation to REspond to Patient portal messages, which sends messages in response to patient portal messages to both increase documentation of care partners in the electronic health record, and support care partners with content and resources relevant to their messaged concerns.
2023 Understanding Gaps in Care and Reimbursement for Diverse Populations with Alzheimer’s Disease and Related Dementias: A Claims-Based Analysis. Jevay Grooms, PhD, MA & John Wright, PhD, MBA- Principal Investigators
This project which will involve diverse methods to analyze claims data from FAIR Health (which holds the nation’s largest collection of private healthcare claims) and Medicare claims (subject to approval by the Centers for Medicare & Medicaid Services [CMS]), will illuminate the economic costs and differences in utilization of the range of healthcare services provided to patients with Alzheimer’s disease and related dementias (ADRD) by geographic area and a host of demographic factors, including race and ethnicity.
By illuminating salient treatment patterns and costs among different populations, the study will result in innovative, actionable insights that can be used by stakeholders to address gaps in understanding regarding the extent to which and how ADRD care is delivered to and paid for among diverse populations. Through a rigorous, innovative claims-based data analysis utilizing Medicare Advantage, private claims and Medicare data to examine services, costs and comorbid conditions associated with ADRD, the study will inform a wide range of new reimbursement, care delivery and payment approaches for a variety of healthcare stakeholders (e.g., clinicians, payors, policy makers, consumers and others) at the micro and macro levels.
2023 Comparison of Claims-Based Identification of Alzheimer Disease and Related Dementias Between Traditional Medicare and Medicare Advantage. Ravi Gupta, MD, MSHP- Principal Investigator
Accurate claims-based identification of ADRD diagnoses is important for clinical care, population health management, and risk adjustment. In Medicare Advantage, capitated payments may lead to greater care coordination, chronic care management, and lower utilization of care, including for patients with ADRD. However, capitated payments also strongly incentivize MA insurers to increase coding intensity for prospective risk-adjusted payment levels. In this project, we aim to compare the accuracy of diagnostic codes in Medicare Advantage and Traditional Medicare to identify ADRD in the period between the removal and reintroduction of Medicare risk adjustment for ADRD. Our study will help to develop more accurate diagnostic coding and risk adjustment, which are essential to improving clinical care for patients with ADRD.
2023 Home Health Utilization in Older Adults with Dementia in Traditional Medicare and Medicare Advantage. Jamie Smith, PhD, RN & Jianhui (Frank) Xu, PhD, MPP- Principal Investigators
Co-investigators: Dan Polsky, PhD, Julia G. Burgdorf, PhD
Home health care services has provided crucial health services for persons living with dementia (PLWD) living in the community. Prior work has demonstrated that PLWD use more intensive home health and at greater costs than persons without dementia. However much of our understanding of home health use by PLWD is in the context of traditional Medicare. Given the recent growth in Medicare Advantage and the fundamental differences in the reimbursement models, it is critical to understand how PLWD use home health care with Medicare Advantage. The purpose of this project is to explore differences in home health care use by PLWD between traditional Medicare and Medicare Advantage. This pilot will leverage linked traditional Medicare claims, Medicare Advantage encounter data, and clinician assessments in a national sample of PLWD. We will address essential literature gaps by examining details of the home health episodes (e.g. services used, length of stay) and exploring variations across different Medicare Advantage plan types. Findings will provide an important foundation for future research on the accessibility, quality, and equity of home health care for PLWD.
2023 Mail Order Versus Retail Pharmacy Use Among Medicare Part D Beneficiaries with Alzheimer’s Disease and Related Dementias. Mariana Socal, MD, PhD- Principal Investigator
Co-investigators: Ge Bai, PhD, Jeromie Ballreich, PhD, Jenny Markell, PhD Student
The Medicare program is the primary source of health care spending for the 6.5 million Americans with Alzheimer’s disease and related dementias (ADRD), accounting for 45% of all ADRD health care-related cost, or $146 billion, in 2022. Patients with ADRD require several pharmacologic treatments to maintain their health and quality of life, as well as to treat underlying comorbidities. This study will examine how the use of pharmaceutical treatments through mail order and retail pharmacies affects drug accessibility and affordability for Medicare beneficiaries with ADRD.
2023 Examining Trends in Mechanical Ventilation Among Veterans Living with Dementia and the Role of Palliative Care. Judith Vick, MD, MPH- Principal Investigator
Co-investigators: Cynthia Boyd, MD, Theodore Jack Iwashyna, MD, Jessica Ma, MD, Megan Shepherd-Banigan, PhD, John Pura, PhD, Jennifer Wolff, PhD
Among non-veteran persons living with dementia, the use of mechanical ventilation has doubled in recent years. This growth occurred without an increase in survival and despite evidence that surrogate decision makers of persons with advanced dementia almost universally desire comfort, rather than life prolongation, to be the patient’s goal of care. Trends in mechanical ventilation have not been studied among veterans living with dementia, despite the high prevalence of dementia among veterans over the age of 65. In addition, no study has investigated the association of palliative care use and mechanical ventilation for veterans living with dementia, though prior work has shown that use of palliative care is associated with decreased critical care resource use. In this study, we will construct a national cohort of veterans living with dementia to examine trends in mechanical ventilation and explore the association between receipt of palliative care and mechanical ventilation in this population.
2022 ADRD, Family Caregiving and Children's labor supply in Denmark. Onur Altindag, PhD, MA - Principal Investigator
A significant share of long-term care needs related to ADRD are met informally by family members, many of whom also work, and the increasing demand for care has potential to impede economic growth by reducing formal employment among the working-age population. A full accounting of the economic burden of ADRD must include the substantial spillovers in the form of reduced labor force participation and lost earnings of family caregivers. In this project, we will study the labor supply response to ADRD-related caregiving among adult men and women in Denmark and document the distribution of economic costs within families based on demographic characteristics. Our study will contribute to a greater understanding of the substantial, but often difficult to measure economic consequences that ADRD imposes on families and on national budgets pointing to targeted policies to mitigate these costs.
2022 An Economic Approach to Mental Health and Cognitive Ability in the Elderly. Michael Darden, PhD - Principal Investigator
My research seeks to improve our understanding of the determinants of cognitive decline. I propose to use economic modeling to address two fundamental problems in this literature: dynamic selection and measurement error. Dynamic selection occurs when the composition of data changes over the age profile due to mortality. For example, dynamic selection biases the relationship between cigarette smoking and cognitive health because smokers experience excess mortality. Measurement error occurs when we use proxy measures (e.g., word recall scores) in the place of latent variables (e.g., cognitive health). Economists have developed statistical models for both dynamic selection and measurement error, but my research is the first to apply these methods to cognitive health and its determinants.
2022 Care Partners and Support of Older Adults with Hearing Loss and Dementia. Danielle Powell, AuD, PhD - Principal Investigator
The purpose of this project is to understand the role of care partners in health care in the context of caring for an older adult with hearing loss and dementia. Caring for the growing number of older adults with dementia presents complex medical and communication challenges. These challenges may be compounded in the context of hearing loss where the additional burden of hearing loss among older adults with dementia may place added stressors on cognitive reserve, hinder communication further, and create additional emotional/social burdens on care partners. With this work, we aim to understand how care partners influence health management of older adults with hearing loss and/or dementia to inform future work to improve communication between older adults with dementia, care partners, and clinicians — critical for the health and social/emotional support of older adults and their care partners.
2022 Health Care Service Utilization and Cost of Hip Fracture Care in Older Adults with Dementia. Lisa Reider, PhD, MHS, and Joe Levy, PhD - Co-Principal Investigators
Hip fractures are a significant cause of morbidity and mortality in older adults and have a substantial impact on health care service utilization and cost. Each year over 300,000 older adults are hospitalized for hip fracture in the United States with an estimated annual direct cost of $17 billion dollars. Given the increase in older adults nationally, these numbers are expected to grow. The risk of hip fracture is nearly three times higher in older adults with dementia owing to higher rates of osteoporosis and a greater propensity for falls. Nearly 40% of older adults with hip fracture are cognitively impaired and are more likely to experience post-operative complications, longer lengths of hospital stay, hospital readmission and greater loss of independent function. This is a vulnerable group that require a higher treatment focus and more resources to meet their complex needs, though little is known about the incremental service utilization and cost associated with dementia for hip fracture. Therefore, we will compare health care service utilization and cost for hip fracture among older adults with versus without dementia using 20% Medicare FFS claims and will determine if dementia is predictive of higher cost independent of standard risk adjustment variables. This research has important implications for future bundled payment policy and the provision of value-based care for these individuals.
2021 Examining Emergency Department Length of Stay for Older Adults with Dementia. Stephanie Nothelle, MD– Principal Investigator
Older adults with dementia go to the Emergency Department (ED) more frequently than older adults without dementia. The ED is a potentially overstimulating environment for older adults with dementia given the background noise, large number of unfamiliar people and interrupted opportunities for sleep. Further, the ED is associated with higher costs of care for older adults with dementia compared to those without dementia, placing financial strain on patients, families and society. Given these risks, reducing the time spent in the ED, particularly from long extremes is important for older adults with dementia. In this study we will determine if length of stay in the ED is longer for older adults with dementia and if there are any facility characteristics associated with longer lengths of stay for older adults with dementia. These results will serve as important foundational information that could be used to target ED dementia care interventions.
2021 Genetic Risk for Alzheimer’s Disease and Later-Life Decisions and Outcomes: Exploring the Role of the Family and Human Capital. Nicholas W. Papageorge, PhD, MA– Principal Investigator
The purpose of this project is to use data on genetic propensities to develop ADRD to better understand the life course trajectories of people who may eventually develop ADRD, including their educational attainment, work life, income, financial decisions, and wealth accumulation. Of particular interest are individuals who are not diagnosed with ADRD or who do not exhibit significant cognitive decline according to standard measures (either because they lack access to medical care or, alternatively, because their condition is mild enough or their environment protective enough that cognitive decline falls under the radar). Using genetic data to better understand people who may not exhibit cognitive decline using standard measures or who are not diagnosed can help us to better understand the full extent of ADRD. Preliminary results suggest that many people with a genetic propensity for ADRD and who are not diagnosed and who do not exhibit strong cognitive decline according to standard measures still exhibit other negative outcomes (e.g., earlier retirement or less wealth) suggesting that the ways we currently diagnose or recognize illness are not sufficient to capture the full population in need of treatment. Findings will not only help us to recognize more potential patients, but may also help us to understand treatment. If some people with a genetic propensity for ADRD do not exhibit symptoms, it may be by chance, but may also be because policy-modifiable environmental factors are protective. Understanding what these factors are and why they are protecting could eventually be used to inform best treatment practices.
2021 Use of high-cost care among Veterans with comorbid mental illness and Alzheimer’s and related dementia. Megan Shepherd-Banigan, PhD, MPH- Principal Investigator
We will examine 12-month health care use patterns among Veterans 65+ with pre-existing mental illness and a new Alzheimer’s Disease and Related Dementias (ADRD) diagnosis. Specifically, we will examine the extent to which pre-existing mental illness is a risk factor for poor quality care for individuals with ADRD. The incidence of ADRD is projected to increase exponentially in the coming decades and mental illness is associated with a 2-fold higher risk for developing ADRD. Co-occurrence of ADRD and mental illness likely complicates health care delivery for this population, yet there is little understanding of the implications of this co-occurrence on service utilization patterns which drive Medicare costs. Findings from this study will provide information about the extent to which pre-existing mental illness impedes high quality care for older adults with ADRD, as evidenced by higher ED use, inpatient visits, and 30-day readmissions. This information will provide a foundation upon which to develop health system strategies that improve care coordination and quality for this understudied population.
2021 Dementia and sensory impairment: Economic consequences for patients and caregivers. Varshini Varadaraj, MD, MPH – Principal Investigator
Dementia and sensory impairment are salient features of aging that share common risk factors, and sensory impairment is itself a risk factor for cognitive decline. These commonly co-occurring conditions may be associated with impairment in financial capacity, putting older adults at risk for financial loss and fund mismanagement. In addition, caring for older adults with chronic conditions may be associated with financial difficulties among caregivers. Financial capacity is central to older adults’ independence and well-being, and their caregivers’ welfare and capacity for caregiving. Therefore, a deeper understanding of the interplay between dementia and sensory impairment and the impact of the resultant cumulative risk on financial wellbeing of older adults and their caregivers is required. This project aims to examine the economic impact (income, economic wellbeing, financial literacy) of having co-occurring dementia and sensory impairment (vision and hearing impairments) on older adults, and their family caregivers, using nationally representative data. The resulting findings will highlight gaps and opportunities for the development of supportive services and policies to help older adults with financial management.
2020 Case-identification of persons with Alzheimer's Disease and Alzheimer's Disease Related Dementia: A methods study to compare diagnoses in structured and unstructured electronic health record data. Hadi Kharrazi, MD, PhD – Principal Investigator
Alzheimer’s Disease Related Dementia (ADRD) is poorly coded in electronic health records (EHRs). To address this gap, this study aims to assess the reliability of ADRD coding in EHRs, and then compare the value of unstructured EHR data in identifying patients with ADRD. Results of this study can enhance our understanding of EHR’s data value in accurately identifying ADRD patients. Study conclusions may improve the use of EHRs to assess patient eligibility in clinical trials and denominator selection for health services research projects targeting the older adults.
2020 Race Differences in Supportive Service Utilization by White and Black Caregivers of Persons with ADRD. Chanee Fabius, PhD, MA – Principal Investigator
The purpose of this project is to determine whether the use of supportive services varies by race for black and white caregivers of persons with Alzheimer’s Disease and Related Dementias (ADRD). Persistent health disparities experienced by Black persons living with dementia (PLWD) likely place an added demand on family and unpaid caregivers. There is limited understanding of supportive services accessed by caregivers of PLWD and how utilization may vary by caregiver and care recipient characteristics, particularly across race groups. More information is needed to address the needs of this growing population, inform the design of relevant and effective programs and practices, and increase the capacity of providers and policymakers to serve diverse groups of people impacted by ADRD. Findings from this pilot will provide important information about the current landscape of support for racially diverse ADRD caregivers and better inform strategies to help persons with ADRD and their family and unpaid caregivers.
2020 Quantifying Potentially Avoidable Financial Losses Due to Dementia Lauren Nicholas, PhD – Principal Investigator
Dementia represents a threat to retirement security for patients and families because characteristic brain changes make it difficult to remember routine financial characteristics and alter risk perception, increasing susceptibility to fraud and exploitation. Yet little is known about the prevalence and magnitude of financial losses due to dementia and the potential unmet need for assistance with financial management among persons with Alzheimer’s Disease and Related Dementias (ADRD). With no public and/or private sector policies to protect the financial interests of persons with ADRD, there is an urgent need to understand the magnitude of the issue and develop methods to monitor incidence over time so that effective policies can be developed. This pilot project will collect new survey data to assess the prevalence and magnitude of financial losses associated with cognitive impairment and to assess the demographic characteristics of patients and families affected by these losses.
2020 Assessing State Variability in Measures of Dementia Prevalence. Emmanuel Drabo, PhD – Principal Investigator
The purpose of this pilot study is to contribute new and more robust estimates of state-level measures of Alzheimer’s Disease and Related Dementias (ADRD) prevalence and potential variability in prevalence from multiple national datasets (American Community Survey, Behavioral Risk Factor Surveillance System, National Health Interview Survey, and Medicare Claims) with both self-reported measures and diagnosed ADRD. The evidence generated by this research will directly support Drabo’s planned career development application to NIA around ADRD diagnosis and care burden. The anticipated outcome from this proposed training plan and research agenda is to contribute stronger and more robust information regarding state-level estimates of ADRD prevalence to set the stage for further work to quantify ADRD burden, and to permit dementia-related research in various rich, less restrictive, and relatively user-friendly data sources.
2020 Variation in Medicare Home Health Costs Associated with Patient Cognitive Impairment. Julia Burgdorf, PhD – Principal Investigator
Older adults with Alzheimer’s Disease and Related Dementias (ADRD) have uniquely challenging care needs, large comorbidity burdens, and are heavy users of health care; they comprise an estimated one-third of the patient population in Medicare-funded home health care. Current risk-adjustment models for Medicare home health reimbursement fail to account for whether a patient has ADRD. This omission has the potential to threaten access to care for this vulnerable subpopulation. Using linked survey, patient assessment, and claims data, this pilot will provide the first evidence regarding the relationship between patient cognitive impairment and costs of care during Medicare-funded home health care. Findings will offer a better understanding of the resources needed to provide skilled care at home for older adults with ADRD and may inform future revisions to the Medicare home health reimbursement model.