Dementia Coding, Workup, and Treatment in the VA New England Healthcare System.
Growing evidence suggests that Alzheimer's disease and other types of dementia are underdiagnosed and poorly documented. In our study, we describe patterns of dementia coding and treatment in the Veteran's Administration New England Healthcare System. We conducted a retrospective cohort study with new outpatient ICD-9 codes for several types of dementia between 2002 and 2009. We examined healthcare utilization, medication use, initial dementia diagnoses, and changes in diagnoses over time by provider type. 8,999 veterans received new dementia diagnoses during the study period. Only 18.3% received a code for cognitive impairment other than dementia, most often "memory loss" (65.2%) prior to dementia diagnosis. Two-thirds of patients received their initial code from a PCP. The etiology of dementia was often never specified by ICD-9 code, even by specialists. Patients followed up exclusively by PCPs had lower rates of neuroimaging and were less likely to receive dementia medication. Emergency room visits and hospitalizations were frequent in all patients but highest in those seen by dementia specialists. Dementia medications are commonly used off-label. Our results suggest that, for the majority the patients, no prodrome of the dementia syndrome is documented with diagnostic code, and patients who do not see dementia specialists have less extensive diagnostic assessment and treatment.
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA ; Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 150 S. Huntington Avenue, Boston, MA 02130, USA.
Kelly
0000-0003-1727-7076
K
Cho
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA ; Boston University School of Public Health, Boston, MA, USA.
David R
DR
Gagnon
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA ; Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 150 S. Huntington Avenue, Boston, MA 02130, USA ; New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA.
Jane A
JA
Driver
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA.
Arman
A
Altincatal
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA.
Nicole
N
Kosik
United BioSource Corporation, Lexington, MA, USA.
Stephan
S
Lanes
Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, USA ; Division of Aging, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 150 S. Huntington Avenue, Boston, MA 02130, USA ; Boston University School of Public Health, Boston, MA, USA.
Elizabeth V
EV
Lawler