iCAREFOR: Interhospital Care Fragmentation in Older Adults with Dementia

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PROJECT SUMMARY When a patient is readmitted to a different hospital than the one they were previously discharged from, fragmentation of care occurs. Such fragmented readmissions are associated with a number of negative patient outcomes, including a nearly two-fold increased risk for mortality. Preliminary analyses by Dr. Sara Turbow, the PI for this grant, have shown that a diagnosis of Alzheimer’s disease and related dementias (ADRD) was an independent predictor of interhospital care fragmentation. In Aim 1, she will use Medicare data to estimate the association between inpatient fragmentation of care and either a) emergency department arrival via an ambulance or b) coming from a post-acute care facility. We hypothesize that ambulance use and post-acute care facility residence will contribute to the higher prevalence of interhospital care fragmentation in older adults with ADRD. In Aim 2, Dr. Turbow will examine the association between information sharing across hospitals and patient outcomes in older adults with ADRD by comparing fragmented readmissions between hospitals that share data via a health information exchange versus those that do not. In Aim 3, she will survey health professionals and interview health system leaders to ascertain critical barriers and facilitators to information sharing between healthcare settings. This proposal directly addresses the mission of the National Institute on Aging and of the National Plan to Address Alzheimer’s Disease, specifically to optimize care quality and efficiency for older adults with ADRD, and the applications of this research have implications for dementia care and health disparities research in ADRD. The proposed aims will be completed under the superlative mentorship of Dr. Mohammed K. Ali (expertise in health services research and implementation science), Dr. Camille Vaughan (expertise in aging/geriatrics research), Dr. Molly Perkins (expert in qualitative methods), Dr. Kimberly Rask (expert in health services research/health economics), and Dr. Steven Culler (Medicare data expert), as well as faculty at Emory’s Goizueta Alzheimer’s Disease Research Center. Emory University has ample resources to allow Dr. Turbow to carry out her research aims. Her training plan is structured to include formal didactic training at Emory and online via the UCSF Implementation Science Certification Program. The research aims and training plan will position Dr. Turbow to become an independently funded health services and aging researcher.