Continuity of care and health care cost among community-dwelling older adult veterans living with dementia.

Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.

Independent Living* ; Veterans*; Continuity of Patient Care/*organization & administration ; Dementia/*economics ; Health Expenditures/*statistics & numerical data ; Medicare/*economics; Aged ; Aged, 80 and over ; Continuity of Patient Care/economics ; Emergency Service, Hospital/economics ; Female ; Health Services/economics ; Homes for the Aged/economics ; Humans ; Male ; Nursing Homes/economics ; United States

Objectives: To estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community-dwelling older veterans with dementia.
Data Sources: Combined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014-2015.
Study Design: FY 2014 COC was measured by the Bice-Boxerman Continuity of Care (BBC) index on a 0-1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long-/short-stay nursing home, and noninstitutional long-term care (LTC) cost for medical (like skilled-) and social (like unskilled-) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders.
Data Collection: Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N = 102 073).
Principal Findings: Mean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35 425. A 0.1 higher BBC resulted in (a) $4045 lower total cost; (b) $1597 lower acute inpatient cost, $119 lower ED cost, $4368 lower long-stay nursing home cost; (c) $402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short-stay nursing home cost.
Conclusions: COC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.
(© Health Research and Educational Trust.)

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Keywords: VA health care system; aging/elderly/geriatrics; dementia; health care cost; instrumental variables; primary care

Date Created: 20200820 Date Completed: 20211203 Latest Revision: 20220716

20231215

PMC8143692

10.1111/1475-6773.13541

32812658