title: A program to improve detection of undiagnosed dementia in primary care and its association with healthcare utilization.
abstract: OBJECTIVE
  Alzheimer's disease and related dementias are common and costly, with increased healthcare utilization for patients with these disorders. The current study describes a novel dementia detection program for veterans and examines whether program-eligible patients have higher healthcare utilization than age-matched comparison patients.
  
  
  METHODS
  Using a telephone-based case-finding approach, the detection program used risk factors available in the electronic medical record (EMR) and telephone-based brief cognitive screening. Holding illness severity constant, dementia detection and healthcare utilization were compared across age-matched groups with and without program risk factors.
  
  
  METHODS
  Five Veterans Affairs Healthcare Network Upstate New York primary care clinics.
  
  
  METHODS
  Veterans aged 70 years and older.
  
  
  METHODS
  EMR data and the Charlson comorbidity index.
  
  
  RESULTS
  Program-eligible patients (n = 5,333) demonstrated significantly greater levels of medical comorbidity relative to comparison patients and were on average more than twice as likely to be admitted to the hospital. They also had nearly double the number of outpatient visits to several services. Similar patterns were seen in those who screened positive on a brief cognitive measure, compared with those who screened negative.
  
  
  CONCLUSIONS
  A novel program using EMR data to assist in the detection of newly diagnosed dementia in a clinical setting was found to be useful in identifying older veterans with multiple comorbid medical conditions and increased utilization of hospital and clinic services. Results suggest undetected cognitive impairment and dementia may significantly contribute to healthcare utilization and costs of care in older veterans.
authors: VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Division of Geriatrics/Gerontology, Department of Medicine, School of Medicine and Biomedical Sciences University at Buffalo, Buffalo, New York. Electronic address: laura.wray@va.gov.
authors: Laura O
authors: LO
authors: Wray
authors: VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, New York.
authors: Michael
authors: M
authors: Wade
authors: VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; School of Nursing, University at Buffalo, The State University of New York, Buffalo, New York; School of Public Health and Health Professions, University at Buffalo, The State University of New York, Buffalo, New York.
authors: Gregory P
authors: GP
authors: Beehler
authors: Department of Neurology, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma.
authors: Linda A
authors: LA
authors: Hershey
authors: VA Center for Integrated Healthcare, VA Western New York Healthcare System, Buffalo, New York; Department of Psychology, University of Colorado, Colorado Springs, Colorado.
authors: Christina L
authors: CL
authors: Vair
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003704:Dementia / Q000175:diagnosis*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D009518:New York; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D058996:Quality Improvement; D012307:Risk Factors; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data; D058014:Veterans Health / Q000706:statistics & numerical data
keywords: Dementia detection; healthcare utilization; primary healthcare; telephone-based case-finding