A Longitudinal Network Study of Alzheimer's and Dementia Care in Relation to Disparities in Access and Outcomes - PROJECT SUMMARY/ABSTRACT
Alzheimer's disease and related dementias (AD/dementia) represent a looming public
health crisis, affecting roughly 5 million people in the U.S. and 11% of older adults. As with other
chronic conditions, racial/ethnic and socio-economic disparities exist in the prevalence and
burden of illness. However, less is known about how disparities in access to care influence the
care trajectories – i.e. the scope, frequency and sequence of services used across health care
settings – of those with AD/dementia. This retrospective, longitudinal cohort study will address
this gap by using network analysis to examine care trajectories and outcomes in a racially and
socioeconomically diverse sample of community-dwelling individuals with AD/dementia and
unspecified cognitive impairment (CI) who may be at risk for a delayed AD/dementia diagnosis.
The cohort will consist of home health care patients served by the Visiting Nurse Service of New
York (VNSNY), a large, non-profit home care provider. Data will include clinical assessments for
roughly 89,000 patients admitted to home care during 2010-2012 linked with 4 years of
Medicare and Medicaid claims data and geographic data on neighborhood services. The
specific aims are to:
(1) Describe the population at VNSNY within two diagnostic categories (AD/dementia
and unspecified CI) in relation to adverse outcomes (e.g. pressure ulcers, falls, infection,
dehydration, preventable hospitalization, and nursing home admission);
(2) Map, quantify and compare patterns in the care trajectories of individuals and groups
that experience variable and/or disparate outcomes; and
(3) Identify strategies for implementing care trajectories with potential to reduce
disparities in access and/or outcomes for AD/dementia and unspecified CI.
Applying a systems science framework, the study will use innovative network analytics to
capture complex patterns in care trajectories that may contribute to adverse outcomes in a
racially and socioeconomically diverse sample of individuals with these two conditions. The
long-term goal of this research is to identify and, in subsequent studies, test potential home- and
community-based interventions that may improve access to services and outcomes for
individuals who may be underserved or at heightened risk for unmet healthcare needs. This
research will produce new knowledge to aid efforts to mitigate health disparities in this
vulnerable and growing population.
