Skilled Nursing Facility Participation in Health Information Exchange and Quality of Care for Patients with Alzheimer's Disease and Related Dementias

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PROJECT SUMMARY/ABSTRACT Each year there are 1.5 million skilled nursing facility (SNF) stays for post-acute care among Medicare fee-for- service beneficiaries with Alzheimer’s disease or related dementias (ADRD), representing over 60% of beneficiaries who receive care in SNFs. ADRD patients often face unique challenges, including an inability to describe their diagnoses and symptoms or to participate in care planning, which may contribute to a higher likelihood of SNF use following hospitalization and poor outcomes. Following hospitalization, ADRD patients are four times more likely to be discharged to a SNF compared to patients without ADRD. SNF patients with ADRD have worse outcomes than other SNF patients, including higher re-hospitalization rates, longer SNF stays, and a lower likelihood of being discharged back to the community. Insufficient information-sharing capabilities between the SNF, the hospital, and other providers are thought to contribute to the frequency of these events. SNFs were not eligible to receive incentive payments through the Medicare and Medicaid EHR Incentive Programs that led to widespread adoption of health information technology among hospitals and physicians. HIE participation is now being actively promoted by policymakers as means to improve the quality of care in SNFs. However, there is no evidence of its ability to do so for SNF patients with ADRD. This is likely due to a lack of available data on SNF participation in HIE that includes key information, such as dates of HIE participation. In this project, a novel data source will be used that includes dates of HIE participation for all SNFs participating in HIE in New York State over an eight-year period (2012-2019). These data will be merged with a 100% sample of Medicare claims for all beneficiaries in the state who received care in SNFs during the study period to examine the relationship between SNF participation in HIE and the quality and the cost of care for patients with ADRD. The relationship between SNF participation in HIE and the quality of care will also be examined specifically for dual-eligibles and racial minorities with ADRD, who are more likely to receive fragmented care of lower quality compared to other Medicare beneficiaries. Our research design utilizes a difference-in-differences framework using the differential timing of SNF participation in HIE and incorporates an instrumental variable based on a patient’s residence and the differential distance between the nearest SNF with HIE and the nearest SNF without HIE. The robust study design will allow estimation strongly indicative of causation. The results of the proposed project will be important regardless of our findings. It will be the first investigation of whether HIE participation among SNFs (1) improves the quality of care, (2) lowers health care costs, or (3) reduces income and racial disparities in the quality of care for ADRD patients. The information will be useful to policymakers, SNF and hospital executives, physicians, patients, and leaders of health information exchanges.