Factors Associated with Healthcare Utilization Among Community-Dwelling Adults with Clinical Features of Dementia with Lewy Bodies - Project Summary The population of older adults and incidence of dementia are expected to increase significantly over the next several decades. Dementia with Lewy bodies (DLB) is the second most common form of dementia following Alzheimer’s disease (AD). DLB is a significant health burden due to high levels of caregiver stress, cognitive decline, psychiatric disorders, autonomic dysfunction, sleep disturbances, and parkinsonism. Dementia is associated with increased utilization of healthcare services compared to non-demented older adults. Individuals with DLB have significantly higher rates of hospitalizations and longer lengths of stay relative to other forms of dementia. Furthermore, patients with DLB tend to have poor outcomes following hospitalization and are more likely to be discharged from the hospital to a higher level of care than patients with AD. The goal of the research proposal is to identify modifiable factors related to increased healthcare utilization, defined as rates of hospitalization, 30-day readmissions, and emergency department visits, in patients with DLB. Ultimately, we aim to identify key factors that could be addressed to prevent distressing and costly hospitalizations and emergency visits for patients with DLB. Delays in dementia diagnosis are also correlated with increased healthcare utilization. DLB is often under recognized. Patients with undiagnosed DLB may be at increased risk of hospitalization due to the use of treatments that are contraindicated in this disorder. For example, patients with DLB often experience psychosis, but they also are more likely to have adverse reactions to antipsychotic medications relative to individuals with other dementia subtypes. Misdiagnosis in DLB is also common and may underestimate the true economic burden of DLB in existing healthcare utilization studies. The current proposal leverages Medicaid, Medicare, and commercial claims data combined with electronic medical records and random chart audits to evaluate rates of healthcare utilization for DLB compared to AD, vascular dementia, unspecified dementia, and healthy controls. To study the impact of potentially undiagnosed DLB on service utilization, this study includes a method of identifying patients with an unspecified dementia diagnosis who have been treated for core and supportive clinical features of DLB. Comorbid medical conditions, polypharmacy, multidisciplinary care, and participation in specialty diagnostic services will be investigated as possible factors related to rates of healthcare utilization among patients with DLB and other forms of dementia. Identifying factors associated with increased healthcare utilization among patients with DLB and dementia patients with clinical features of DLB is critical. Based upon the findings of this study, we will design and implement a targeted intervention within the electronic medical record to help treating providers make clinical decisions to identify undiagnosed cases, improve care, and prevent hospitalizations for patients with DLB.
