The Effects of Dementia Care Co-Management on Acute Care, Hospice, and Long-Term Care Utilization

J Am Geriatr Soc. 2020 Nov;68(11):2500-2507. doi: 10.1111/jgs.16667. Epub 2020 Jun 23.


Background/objectives: Although nurse practitioner dementia care co-management has been shown to reduce total cost of care for fee-for-service (FFS) Medicare beneficiaries, the reasons for cost savings are unknown. To further understand the impact of dementia co-management on costs, we examined acute care utilization, long-term care admissions, and hospice use of program enrollees as compared with persons with dementia not in the program using FFS and managed Medicare claims data.

Design: Quasi-experimental controlled before-and-after comparison.

Setting: Urban academic medical center.

Participants: A total of 856 University of California, Los Angeles (UCLA) Alzheimer's and Dementia Care program patients were enrolled between July 1, 2012, and December 31, 2015, and 3,139 similar UCLA patients with dementia not in the program. Comparison patients were identified as having dementia using International Classification of Diseases-9 codes and natural language processing of clinical notes. Coarsened exact matching was used to reduce covariate imbalance between intervention and comparison patients.

Intervention: Dementia co-management model using nurse practitioners partnered with primary care providers and community organizations.

Measurements: Average difference-in-differences per quarter over the 2.5-year intervention period for all-cause hospitalization, emergency department (ED) visits, intensive care unit (ICU) stays, and number of inpatient hospitalization days; admissions to long-term care facilities; and hospice use in the last 6 months of life.

Results: Intervention patients had fewer ED visits (odds ratio [OR] = .80; 95% confidence interval [CI] = .66-.97) and shorter hospital length of stay (incident rate ratio = .74; 95% CI = .55-.99). There were no significant differences between groups for hospitalizations or ICU stays. Program participants were less likely to be admitted to a long-term care facility (hazard ratio = .65; 95% CI = .47-.89) and more likely to receive hospice services in the last 6 months of life (adjusted OR = 1.64; 95% CI = 1.13-2.37).

Conclusion: Comprehensive nurse practitioner dementia care co-management reduced ED visits, shortened hospital length of stay, increased hospice use, and delayed admission to long-term care.

Keywords: care management; dementia; healthcare utilization.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Advanced Practice Nursing / organization & administration*
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / epidemiology
  • Alzheimer Disease / therapy*
  • Comprehensive Health Care / organization & administration*
  • Controlled Before-After Studies
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospice Care / statistics & numerical data
  • Hospitalization / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Male
  • Practice Patterns, Nurses'
  • Primary Health Care / organization & administration*