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Health Services Research & Development

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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3111 — The VISN 2 Dementia Case-Finding Program: An Evidence-Based Approach to Support the Recognition of Dementia in Primary Care

Wray LO (VISN 2 Center for Integrated Healthcare), Wade M (VISN 2 Center for Integrated Healthcare), Beehler GB (VISN 2 Center for Integrated Healthcare)

Objectives:
To evaluate a new evidence-based primary care case-finding program to improve identification of Veterans at risk for dementia and to compare health care utilization in older Veterans with and without risk factors for dementia.

Methods:
The VISN 2 dementia case-finding program uses evidence-based dementia risk factors extracted from the electronic medical record (EMR) to identify older Veterans (age > or = 75) who would be appropriate for dementia screening prior to a primary care appointment. Using Kaplan-Meier survival analysis, cumulative dementia-free probability was compared between 5082 Veterans who met criteria for the program and 5082 age-matched controls. Health care utilization was also compared between the two groups.

Results:
Survival analysis showed an increased hazard ratio for program-eligible Veterans as compared to age-matched controls (HR = 1.28; 95% CI: 1.07-1.53; p = 0.007) suggesting that the program selection process is successfully identifying veterans at risk for the onset of dementia. Mean number of all outpatient visits is significantly greater (p < 0.001) in program-eligible Veterans (21.0 ± 0.311 visits during the study period) versus age-matched controls (10.7 ± 0.162 visits during the study period).

Implications:
Using the EMR, the VISN 2 dementia case-finding program successfully identifies Veterans who are at increased risk for dementia. This same group of Veterans utilizes nearly twice the outpatient resources as their age matched peers, suggesting that there is a quality gap in VA’s primary care for older Veterans who are at risk for dementia. This presentation will also include more detailed analyses of outpatient and inpatient healthcare utilization in older Veterans with and without risk factors for dementia.

Impacts:
Improved recognition of dementia in primary care is the first step in improving the quality of primary care services for older Veterans with dementia. Better understanding of health care utilization patterns may provide justification for dissemination and further implementation of dementia case-finding approaches and can suggest targets for quality improvement efforts in this population.


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