Beschreibung:
<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Although nearly 40% of older adults receive care in Medicare Advantage (MA) plans, there are limited information on whether the patterns of dementia diagnosis and health care utilization differ from traditional Medicare fee‐for‐service. We examined first ADRD diagnoses by provider type and clinical setting and compared patient socio‐demographic and clinical characteristics across a large integrated health care system in southern California.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patients 65 years and older who were continuously enrolled in the health plan for at least one year prior to January 1, 2015 and had a first dementia diagnosis code during the study period (January 1, 2015‐ December 31, 2018) were included in the analysis. Providers classified as dementia specialists included neurologists, psychiatrists, and geriatricians; all other providers were considered nondementia specialists and mostly represented primary care. Data were derived from electronic health records.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>There were a total of 25,278 incident ADRD codes over the entire study period, slightly more than half assigned in ambulatory care and the remainder during a hospital‐based encounter. For the clinic‐diagnosed cohort (n=13,962), other than a slightly younger age for those diagnosed in neurology/psychiatry compared to geriatrics or primary care (79 vs. 82 years old), there were no other differences, including race/ethnicity or spoken language. Compared to the clinic cohort, the hospital‐diagnosed cohort (n=11,316) was slightly older (83 vs. 81 years old), more likely to be white (59% vs. 53%) and English speaking (90% vs. 85%); had more missed appointments (13% vs. 10%) and were more likely to have a non‐dementia cognitive impairment code in the two years prior (36% vs. 31%). They also had a higher burden of co‐morbidity (8.7 ± 3.8 vs. 7.0 ± 3.4) and higher rate of documented advance directive or POLST (49% vs. 41%) (all, p<.01).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Nearly half of the incident ADRD codes were associated with a hospital‐based encounter. Patients first diagnosed with ADRD in the hospital setting were generally older and sicker compared to patients diagnosed in the clinic. Given such differing socio‐demographic and clinical characteristics at diagnosis, claims based studies should distinguish patients first diagnosed in hospital vs. clinic‐based settings.</jats:p></jats:sec>