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Identifying Approaches to Measure and Reduce Harmful, Low-Value Care Among Older Americans with Mild Cognitive Impairment and Dementia

Award Number: R01AG070017
ORGANIZATION: NATIONAL INSTITUTE ON AGING
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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ABSTRACT Low-value care is patient care that provides no net benefit in specific clinical scenarios, and often causes harm. Older adults with mild cognitive impairment and dementia (MCID) frequently receive low-value care and are particularly vulnerable to its harms (e.g., routine benzodiazepine drug prescriptions offer limited benefit to adults with MCID and can cause delirium or falls). Reducing the delivery of low-value care can improve health outcomes for this vulnerable group by lessening exposure to harms as well as curtailing unnecessary spending. To begin to reduce the problem of low-value care delivery in older adults with MCID, it is important to understand the extent of the national problem, identify the characteristics of patients and the delivery systems with the greatest risk exposure, and whether two currently implemented U.S. strategies (payment reform and a large education campaign) were associated with less delivery of low-value care among older adults with MCID. In this context, we propose three specific aims: 1) to generate national estimates of low-value care trends, costs, and harms in older adults with MCID (2008–2018), 2) to identify subgroups of older adults with MCID at the greatest risk of receiving low-value care, and 3) to assess whether two U.S. strategies were associated with less low-value care delivered to older adults with MCID. We propose to achieve these aims by linking Medicare claims data with the Health and Retirement Study (HRS), which is a nationally representative longitudinal study of community-dwelling and institutionalized older Americans on the health and economic changes of aging. We will pursue these aims using national longitudinal data and by applying rigorous analytical approaches such as interrupted time series methods with contemporaneous control groups. Ultimately, we seek to build a foundation of evidence to inform future U.S. health policies that can reduce low-value care and improve patient-oriented outcomes in older Americans with MCID.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $463,556 )
2025	2025	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Aging Research	000	5	11/8/2024	NON-COMPETING CONTINUATION	$463,556
														Subtotal = $463,556

Issue Date FY: 2024 ( Subtotal = $525,686 )
2024	2024	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Aging Research	001	4	5/13/2024	NON-COMPETING CONTINUATION	$52,568
2024	2024	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Aging Research	000	4	11/3/2023	NON-COMPETING CONTINUATION	$473,118
														Subtotal = $525,686

Issue Date FY: 2023 ( Subtotal = $525,686 )
2023	2023	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Aging Research	000	3	1/13/2023	NON-COMPETING CONTINUATION	$525,686
														Subtotal = $525,686

Issue Date FY: 2022 ( Subtotal = $525,686 )
2022	2022	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Aging Research	001	2	4/22/2022	NON-COMPETING CONTINUATION	$52,569
2022	2022	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90024	LOS ANGELES	USA	Aging Research	000	2	12/9/2021	NON-COMPETING CONTINUATION	$473,117
														Subtotal = $525,686

Issue Date FY: 2021 ( Subtotal = $532,358 )
2021	2021	UNIVERSITY OF CALIFORNIA, LOS ANGELES	10889 WILSHIRE BLVD STE 700	LOS ANGELES	CA	90095	LOS ANGELES	USA	Aging Research	000	1	12/11/2020	NEW	$532,358
														Subtotal = $532,358

Grand Total All Awards = $2,572,972

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Identifying Approaches to Measure and Reduce Harmful, Low-Value Care Among Older Americans with Mild Cognitive Impairment and Dementia

Award Number: R01AG070017

ORGANIZATION: NATIONAL INSTITUTE ON AGING

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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