Annual wellness visit policy: Impact on disparities in early dementia diagnosis and quality of healthcare for Medicare beneficiaries with Alzheimer's Disease and Its Related Dementias

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PROJECT SUMMARY/ABSTRACT Early recognition of cognitive impairment and timeliness in Alzheimer’s Disease and Related Dementias (ADRD) diagnoses are key to optimal dementia care. Data show that early ADRD recognition is linked to less exposure to potentially inappropriate medications (PIM), less propensity for acute care use, lower rates of falls, and increased adoption of advance care planning. One potential way to improve early recognition of ADRD is Annual Wellness Visits (AWVs)—a free preventive service that covers cognition and fall risk assessment, medication reconciliation, and personalized prevention plans. The Centers for Medicare & Medicaid Services (CMS) began reimbursing AWVs in 2011. The Alzheimer’s Association (AA) has drawn attention to the higher prevalence and risk of ADRD among women than men and black and Hispanic Americans than whites. Receipt of AWVs might decrease health disparities; however, evidence to date is inconsistent. This 5-year R01 project has a focus on community-dwelling ADRD patients and is based on the Institute for Healthcare Improvement’s 4Ms framework of an age-friendly health system, 4Ms: what matters, mentation, mobility, and medication. We will conduct a convergent parallel mixed-methods design research study to assess the effect of AWV policy on early ADRD diagnosis and reducing health disparities. We will analyze national Medicare data, health retirement survey-Medicare linkage data, and National Health & Aging Trends study-Medicare linkage data to understand the effect of AWV implementation on reducing health disparities across sex, racial/ethnic, socioeconomic status, and rural/urban residence. Also, we will collect primary data (phone interviews) from 180 family caregivers of ADRD patients (~30 in each of the 6 groups: Hispanic men, Hispanic women, black men, black women, white men, and white women) and 400 clinicians (~100 in each of 4 Medicare regions, ~25 in each of 4 credential areas: family medicine, internal medicine primary care, geriatricians, nurse practitioners) to understand how AWV is delivered to ADRD patients in order to identify the potential mechanism for reducing health disparity through AWV. For family caregivers, we will use a snowball sampling method with AA’s and Rotary International networks, and AA’s TrialMatch® platform to reach potential subjects nationwide. For clinicians, we will randomly select clinicians nationwide from the 2019 CMS doctors and clinicians national file. We will partner with AA to ensure sound data collection and development of practical implications to inform policy/practice. Our three specific aims are: Aim 1: Assess the effects of AWV on the timeliness of ADRD diagnosis (mentation); Aim 2: Assess the effects of AWV on advance care planning consultation (what matters), depression (mentation), fall and fracture (mobility), and PIM use and ADRD treatment (medication) for ADRD patients across sex, racial/ethnic, socioeconomic status, and rural/urban residence; and Aim 3: Identify what works and what does not work in AWV delivery for ADRD patients.