PROJECT SUMMARY/ABSTRACT
Each year there are 1.5 million skilled nursing facility (SNF) stays for post-acute care among Medicare fee-for-
service beneficiaries with Alzheimer’s disease or related dementias (ADRD), representing over 60% of
beneficiaries who receive care in SNFs. ADRD patients often face unique challenges, including an inability to
describe their diagnoses and symptoms or to participate in care planning, which may contribute to a higher
likelihood of SNF use following hospitalization and poor outcomes. Following hospitalization, ADRD patients
are four times more likely to be discharged to a SNF compared to patients without ADRD. SNF patients with
ADRD have worse outcomes than other SNF patients, including higher re-hospitalization rates, longer SNF
stays, and a lower likelihood of being discharged back to the community. Insufficient information-sharing
capabilities between the SNF, the hospital, and other providers are thought to contribute to the frequency of
these events. SNFs were not eligible to receive incentive payments through the Medicare and Medicaid EHR
Incentive Programs that led to widespread adoption of health information technology among hospitals and
physicians. HIE participation is now being actively promoted by policymakers as means to improve the quality
of care in SNFs. However, there is no evidence of its ability to do so for SNF patients with ADRD. This is likely
due to a lack of available data on SNF participation in HIE that includes key information, such as dates of HIE
participation. In this project, a novel data source will be used that includes dates of HIE participation for all
SNFs participating in HIE in New York State over an eight-year period (2012-2019). These data will be merged
with a 100% sample of Medicare claims for all beneficiaries in the state who received care in SNFs during the
study period to examine the relationship between SNF participation in HIE and the quality and the cost of care
for patients with ADRD. The relationship between SNF participation in HIE and the quality of care will also be
examined specifically for dual-eligibles and racial minorities with ADRD, who are more likely to receive
fragmented care of lower quality compared to other Medicare beneficiaries. Our research design utilizes a
difference-in-differences framework using the differential timing of SNF participation in HIE and incorporates an
instrumental variable based on a patient’s residence and the differential distance between the nearest SNF
with HIE and the nearest SNF without HIE. The robust study design will allow estimation strongly indicative of
causation. The results of the proposed project will be important regardless of our findings. It will be the first
investigation of whether HIE participation among SNFs (1) improves the quality of care, (2) lowers health care
costs, or (3) reduces income and racial disparities in the quality of care for ADRD patients. The information will
be useful to policymakers, SNF and hospital executives, physicians, patients, and leaders of health information
exchanges.
