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Dementia diagnosis and utilization patterns in a racially diverse population within an integrated health care delivery system
Huong Q. Nguyen, Soo Borson, Peter S. Khang, Annette Magdalene Langer-Gould, Susan E. Wang, Jarrod Athen Carrol, Janet S. Lee. Alzheimer s & Dementia Translational Research & Clinical Interventions, 2022-01-01
Topic: Risk, prevention and care in population studies
ADRD prevalence was 5.5%. A total of 25,278 individuals had an incident ADRD code (rate: 1.2%) over the study period-nearly half during a hospital-based encounter. Hospital-diagnosed patients had higher comorbidities, acute care use before and after diagnosis, and 1-year mortality than clinic-diagnosed individuals (36% vs 11%). Many decedents (58%-72%) received palliative care or hospice. Of the 55% diagnosed as outpatients, nearly two-thirds were diagnosed by dementia specialists; when used, standardized cognitive assessments indicated moderate stage ADRD. Despite increases in advance care planning and visits to dementia specialists in the year after diagnosis, acute care use also increased for both clinic- and hospital-diagnosed cohorts. Similar to other MA plans, ADRD is under-diagnosed in this health system, compared to traditional Medicare, and diagnosed well beyond the early stages, when opportunities to improve overall outcomes are presumed to be better. Dementia specialists function primarily as consultants whose care does not appear to mitigate acute care use. Strategic targets for ADRD care improvement could focus on generating pragmatic evidence on the value of proactive detection and tracking, care planning, and the role of specialists in chronic care management.
Key findings
- A total of 25,278 individuals had an incident ADRD code (rate: 1.2%) over the study period-nearly half during a hospital-based encounter.
- Hospital-diagnosed patients had higher comorbidities, acute care use before and after diagnosis, and 1-year mortality than clinic-diagnosed individuals (36% vs 11%).
- Many decedents (58%-72%) received palliative care or hospice.
- Of the 55% diagnosed as outpatients, nearly two-thirds were diagnosed by dementia specialists; when used, standardized cognitive assessments indicated moderate stage ADRD.
- Despite increases in advance care planning and visits to dementia specialists in the year after diagnosis, acute care use also increased for both clinic- and hospital-diagnosed cohorts.
Why it matters
This study found that Alzheimer's disease and related dementias is under-diagnosed in an integrated health care delivery system compared to traditional Medicare, and diagnosed well beyond the early stages. It suggested that strategic targets for care improvement could focus on generating pragmatic evidence on the value of proactive detection and tracking, care planning, and the role of specialists in chronic care management.
Study details
- Participants25,278
- Effect size5.5%; 1.2%
- Evidence strengthModerate
How this study scored 55/100
Published in a peer-reviewed journal. Scored zero for study design and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Alzheimer s & Dementia Translational Research & Clinical Interventions) |
| Journal's citation record | 1 / 4 | Alzheimer s & Dementia Translational Research & Clinical Interventions: journal h-index 84 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2022 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 25,278 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 3 / 7 | Cited 28 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 4.7 citations a year over 6 year(s) since 2022 |
| Impact for its field and year | 3 / 6 | Cited 3.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 7 other studies in this library |
| Still being cited | 2 / 4 | Cited 19 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Janet S. Lee: h-index 8 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | University of Washington: institution h-index 3,540 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 5 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 35310534) |
| Free to read | 2 / 2 | Free to read |
| Total | 55 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
- DOI: 10.1002/trc2.12279
- PubMed: 35310534
- Original source →
- Free full text: Alzheimer s & Dementia Translational Research & Clinical Interventions →
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Nguyen, H. Q., Borson, S., Khang, P. S., Langer-Gould, A. M., Wang, S. E., Carrol, J. A., et al. (2022). Dementia diagnosis and utilization patterns in a racially diverse population within an integrated health care delivery system. Alzheimer s & Dementia Translational Research & Clinical Interventions. https://doi.org/10.1002/trc2.12279
Vancouver
Nguyen HQ, Borson S, Khang PS, Langer-Gould AM, Wang SE, Carrol JA, et al. Dementia diagnosis and utilization patterns in a racially diverse population within an integrated health care delivery system. Alzheimer s & Dementia Translational Research & Clinical Interventions. 2022. doi:10.1002/trc2.12279. PMID: 35310534.
BibTeX
@article{nguyen2022-35310534,
author = {Nguyen, Huong Q. and Borson, Soo and Khang, Peter S. and Langer-Gould, Annette Magdalene and Wang, Susan E. and Carrol, Jarrod Athen and Lee, Janet S.},
title = {{Dementia diagnosis and utilization patterns in a racially diverse population within an integrated health care delivery system}},
journal = {Alzheimer s \& Dementia Translational Research \& Clinical Interventions},
year = {2022},
doi = {10.1002/trc2.12279},
pmid = {35310534},
url = {https://doi.org/10.1002/trc2.12279}
}
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