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DISPARITIES IN CONTINUITY OF CARE AND USE OF ANNUAL WELLNESS VISITS AMONG OLDER AMERICANS WITH DEMENTIA
Elham Mahmoudi. Innovation in Aging, 2023-12-01
Topic: Risk, prevention and care in population studies
Abstract Working on a risk-adjusted, prospective, capitated payment system, Medicare Advantage (MA) plans are incentivized to offer more efficient and coordinated care than traditional Medicare (TM). This study has two aims: (1) compare the continuity of care and use of annual wellness visits between MA and TM enrollees with Alzheimer’s disease and related dementia (ADRD), and (2) examine Hispanic-White and Black-White disparities in the continuity of care and annual wellness visits by comparing MA with TM enrollees with ADRD. We used a 20% random sample of TM and MA insurance claims (2018-2019). Participants included individuals 65+, with a diagnosis of ADRD, and two years of continuous enrollment in TM (n=129,177) or MA (n=119,130). We used the Bice-Boxerman Continuity of Care Index to measure continuity of care. Generalized linear models were applied. TM lowered the odds of Black and Hispanic individuals having an annual wellness visit [OR=.80 (95% CI:.79-.82)]. Black and Hispanic TM enrollees had lower odds of annual wellness visits as compared to their Black and Hispanic MA counterparts [OR=.83 (95% CI:78-.88) and OR=.88 (95% CI:.83-.94)], respectively. White, Black, and Hispanic MA enrollees had higher continuity of care than their counterparts in TM (27.4 vs. 24.9; 28.9 vs. 28.1; 32.1 vs. 30.1, respectively). MA enrollees with ADRD had higher care continuity than their TM counterparts. Compared to TM, MA increased the odds of annual wellness visits and reduced Hispanic-White disparity in annual wellness visits. Findings from this study can inform policies promoting preventive and equitable care for patients with ADRD.
Key findings
- Black and Hispanic TM enrollees had lower odds of annual wellness visits as compared to their Black and Hispanic MA counterparts [OR=.83 (95% CI:78-.88) and OR=.88 (95% CI:.83-.94)], respectively.
- Compared to TM, MA increased the odds of annual wellness visits and reduced Hispanic-White disparity in annual wellness visits.
Why it matters
Medicare Advantage enrollees with ADRD had higher continuity of care than Traditional Medicare enrollees, and Traditional Medicare lowered the odds of Black and Hispanic beneficiaries having an annual wellness visit. This is about care delivery and disparities by insurance type, not about treating, curing or preventing the disease.
Study details
- Participants129,177
- Evidence strengthLow
How this study scored 35/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Innovation in Aging) |
| Journal's citation record | 0 / 4 | Innovation in Aging: journal h-index 48 (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 | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2023 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 129,177 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| 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 | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 5 year(s) since 2023 |
| Impact for its field and year | 0 / 6 | Cited 0.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Elham Mahmoudi: h-index 29 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Michigan: institution h-index 2,240 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Total | 35 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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. Check the citation against the original before you use it.
APA 7th
Mahmoudi, E. (2023). DISPARITIES IN CONTINUITY OF CARE AND USE OF ANNUAL WELLNESS VISITS AMONG OLDER AMERICANS WITH DEMENTIA. Innovation in Aging. https://doi.org/10.1093/geroni/igad104.0695
Vancouver
Mahmoudi E. DISPARITIES IN CONTINUITY OF CARE AND USE OF ANNUAL WELLNESS VISITS AMONG OLDER AMERICANS WITH DEMENTIA. Innovation in Aging. 2023. doi:10.1093/geroni/igad104.0695.
BibTeX
@article{mahmoudi2023-5b2f8c43,
author = {Mahmoudi, Elham},
title = {{DISPARITIES IN CONTINUITY OF CARE AND USE OF ANNUAL WELLNESS VISITS AMONG OLDER AMERICANS WITH DEMENTIA}},
journal = {Innovation in Aging},
year = {2023},
doi = {10.1093/geroni/igad104.0695},
url = {https://doi.org/10.1093/geroni/igad104.0695}
}
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