The impact of hospital-based health information technology on health care quality and equity among patients with ADRD

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Alzheimer's disease and related dementia (ADRD) is considered one of the most expensive health conditions. Patients with ADRD have more emergency department visits, hospitalizations, ambulatory care sensitivity hospitalization, readmissions, skilled nursing home stays, and home health visits compared to adults without an ADRD diagnosis. Racial and ethnic minorities with ADRD are at high risk for uncoordinated and low-quality care, including higher rates of hospitalizations, preventable hospitalization, avoidable emergency department visits, and health care expenditures. Hospital-based health information technology (hereinafter “hospital-HIT”) is increasingly being used to support care coordination, advance patient engagement, and improve health information exchange. Our team has developed a conceptual framework that delineates the critical roles of hospital-HIT and its application in the care of ADRD patients. Our preliminary findings further show evidence that HIT-supported care can work effectively in ADRD populations. It is critical to implement more robust analyses and comprehensive assessments of the impact of hospital-HIT on health care quality and equity to inform policymakers in the design and implementation of HIT, across the changing needs of ADRD patients (and their caregivers) as dementia progresses. In addition, the COVID-19 pandemic has disproportionately impacted patients with ADRD, especially racial and ethnic minorities. However, the impact of hospital-HIT on health outcomes and equity for persons with ADRD during the pandemic is still lacking. Hence, through the use of ten-year longitudinal dataset before, during, and post the COVID-19 pandemic, and by applying cutting-edge econometric models, this study aims to systematically assess the impact of hospital-HIT on health care quality and equity of patients with ADRD, including the health outcomes during the pandemic. We hypothesize that hospital-HIT that aims to promote care coordination, patient engagement, and data integration can improve health care quality and reduce health care expenditure; and that these impacts will be more pronounced for racial and ethnic minority patients who face substantial barriers to accessing high-quality care. Specifically, we propose to evaluate the impact of hospital-HIT on health care quality (i.e., reduce readmission, preventable ED visits, and preventable hospitalizations) (Aim 1), estimate the extent to which hospital-HIT has reduced racial and ethnic disparities of health care quality and expenditures for the aging population with ADRD (Aim 2); and estimate the extent to which hospital-HIT has impacted health outcomes and quality during the pandemic (Aim 3). Grounded in the HIT-Structural Racism and Discrimination framework for ADRD patients, we expect our results to quantify the impact of hospital-HIT on health care quality for patients with ADRD, including those from racial and ethnic minority groups and communities with different social determinants of health. Results on the impact of hospital-HIT during the pandemic will improve the understanding of how to use hospital-HIT to coordinate care for people with ADRD during the pandemic.