Applications of Claims-Based Frailty Index to Advance Evidence for Frailty-Guided Decision-Making - Extension to ADRD
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PROJECT SUMMARY/ABSTRACT The Centers for Medicare & Medicaid Services introduced Transitional Care Management (TCM) and Chronic Care Management (CCM) services to facilitate care management of high-risk patients. While these services can achieve better health outcomes and reduce health care utilization and costs, they are underutilized due to the lack of awareness and the resource needs for implementation. Particularly, older adults with Alzheimer's Disease and Related Dementia (ADRD) require a significant amount of care coordination and account for a large proportion of ambulatory care sensitive admissions and unplanned readmissions. However, the benefit of TCM and CCM services in patients with ADRD as a whole and by dementia severity remains unknown. Filling this knowledge gap can increase adoption of TCM and CCM services for patients with ADRD. The objective of this supplement to NIA grant R01 AG071809 “Applications of Claims-Based Frailty Index to Advance Evidence for Frailty-Guided Decision-Making” is to evaluate the effectiveness of TCM and CCM services in improving health outcomes and reducing health care utilization and costs in older adults with ADRD. The investigators will use the Medicare 5% random sample data and 2 national surveys of Medicare beneficiaries to test a hypothesis that TCM and CCM services would be associated with reduced readmission and Medicare costs in older adults with ADRD. Additionally, the investigators will examine whether a validated claims-based frailty index, which is closely correlated with functional status and disability, can be a claims-based measure of dementia severity. The specific aims are 1) to evaluate the effectiveness of Medicare TCM service on 60-day readmission rate and Medicare costs after acute hospitalization in Medicare beneficiaries with ADRD; 2) to evaluate the effectiveness of Medicare CCM service on the 1-year home time and health care costs in Medicare beneficiaries with ADRD; and 3) to evaluate whether a claims-based frailty index can be used as a dementia severity measure in Medicare data by comparing it to dementia severity measures derived from clinical assessment in the Medicare Current Beneficiary Survey and the National Health and Aging Trends Study. The investigators will then examine whether the benefit of TCM and CCM services is greater in those with severe dementia than those with mild-to-moderate dementia. The proposed supplement is expected to have a significant impact on the clinical care and health services research of ADRD population by promoting uptake of underutilized care management services and enabling identification of severe dementia from Medicare claims data.
