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Dying with dementia in Medicare Advantage, Accountable Care Organizations, or traditional Medicare
Joan M. Teno, Laura M. Keohane, Susan L. Mitchell, David J. Meyers, Jennifer Bunker, Emmanuelle Bélanger, Pedro L. Gozalo, Amal N. Trivedi. Journal of the American Geriatrics Society, 2021-05-14
Topic: Risk, prevention and care in population studies
Among 370,094 persons with dementia, 93,801 (25.4%) were in MA (mean age [SD], 86.9 [7.7], 67.6% female), 39,586 (10.7%) were ACO attributed (mean age [SD], 87.2 [7.6], 67.3% female), and 236,707 (63.9%) were in TM (mean age [SD], 87.0 [7.8], 67.6% female). The proportion hospitalized in the last 30 days of life was higher among TM enrollees (27.9%) and those ACO attributed (28.1%) than among MA enrollees (20.5%, p ≤ 0.001). After adjustment for socio-demographics, cognitive and functional impairments, comorbidities, and Hospital Referral Region, adjusted odds of hospitalization in the 30 days prior to death was 0.72 (95% confidence interval [CI] 0.70-0.74) among MA enrollees and 1.05 (95% CI 1.02-1.09) among those attributed to ACOs relative to TM enrollees. Relative to TM, the adjusted odds of death in the hospital were 0.78 (95% CI 0.75-0.81) among MA enrollees and 1.02 (95% CI 0.96-1.08) for ACO participants. Dementia decedents in MA had a lower likelihood of IMV use (adjusted odds ratio 0.80, 95% CI 0.75-0.85) compared to TM. Among decedents with dementia, MA enrollees but not decedents in ACOs experienced less costly and potentially burdensome care compared with those with TM. Policy changes are needed for ACOs.
Key findings
- Among 370,094 persons with dementia, 93,801 (25.4%) were in MA (mean age [SD], 86.9 [7.7], 67.6% female), 39,586 (10.7%) were ACO attributed (mean age [SD], 87.2 [7.6], 67.3% female), and 236,707 (63.9%) were in TM (mean age [SD], 87.0 [7.8], 67.6% female).
- The proportion hospitalized in the last 30 days of life was higher among TM enrollees (27.9%) and those ACO attributed (28.1%) than among MA enrollees (20.5%, p ≤ 0.001).
- After adjustment for socio-demographics, cognitive and functional impairments, comorbidities, and Hospital Referral Region, adjusted odds of hospitalization in the 30 days prior to death was 0.72 (95% confidence interval [CI] 0.70-0.74) among MA enrollees and 1.05 (95% CI 1.02-1.09) among those attributed to ACOs relative to TM enrollees.
- Relative to TM, the adjusted odds of death in the hospital were 0.78 (95% CI 0.75-0.81) among MA enrollees and 1.02 (95% CI 0.96-1.08) for ACO participants.
- Dementia decedents in MA had a lower likelihood of IMV use (adjusted odds ratio 0.80, 95% CI 0.75-0.85) compared to TM.
Why it matters
Among people with dementia who died, those in Medicare Advantage were less likely to be hospitalized in the last 30 days of life or die in the hospital compared to those in traditional Medicare. Those in accountable care organizations did not experience less costly or burdensome care compared to traditional Medicare.
Study details
- Participants370,094
- Effect size25.4%; 67.6%; 10.7%
- Evidence strengthLow
How this study scored 53/100
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 (Journal of the American Geriatrics Society) |
| Journal's citation record | 3 / 4 | Journal of the American Geriatrics Society: journal h-index 344 (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 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 4 / 4 | 370,094 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 21 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 3.0 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 3 / 6 | Cited 3.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 5 other studies in this library |
| Still being cited | 1 / 4 | Cited 9 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Amal N. Trivedi: h-index 42 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Vanderbilt University: institution h-index 1,199 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 33989430) |
| Free to read | 2 / 2 | Free to read |
| Total | 53 / 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. The record names 8 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
Teno, J. M., Keohane, L. M., Mitchell, S. L., Meyers, D. J., Bunker, J., Bélanger, E., et al. (2021). Dying with dementia in Medicare Advantage, Accountable Care Organizations, or traditional Medicare. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.17225
Vancouver
Teno JM, Keohane LM, Mitchell SL, Meyers DJ, Bunker J, Bélanger E, et al. Dying with dementia in Medicare Advantage, Accountable Care Organizations, or traditional Medicare. Journal of the American Geriatrics Society. 2021. doi:10.1111/jgs.17225. PMID: 33989430.
BibTeX
@article{teno2021-33989430,
author = {Teno, Joan M. and Keohane, Laura M. and Mitchell, Susan L. and Meyers, David J. and Bunker, Jennifer and Bélanger, Emmanuelle and Gozalo, Pedro L. and Trivedi, Amal N.},
title = {{Dying with dementia in Medicare Advantage, Accountable Care Organizations, or traditional Medicare}},
journal = {Journal of the American Geriatrics Society},
year = {2021},
doi = {10.1111/jgs.17225},
pmid = {33989430},
url = {https://doi.org/10.1111/jgs.17225}
}
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