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. 2023 Sep;19(9):3946-3964.
doi: 10.1002/alz.13052. Epub 2023 Apr 18.

Advanced practice clinician care and end-of-life outcomes for community- and nursing home-dwelling Medicare beneficiaries with dementia

Hyesung Oh  1 , Elizabeth M White  1 , Ulrike Muench  2 , Christopher Santostefano  1 , Bishnu Thapa  1 , Cyrus Kosar  1 , Emily A Gadbois  1 , Zainab Toteh Osakwe  3 , Pedro Gozalo  1 , Momotazur Rahman  1
Affiliations

Advanced practice clinician care and end-of-life outcomes for community- and nursing home-dwelling Medicare beneficiaries with dementia

Hyesung Oh et al. Alzheimers Dement. 2023 Sep.

Abstract

Introduction: Older adults with Alzheimer's disease and related dementias (ADRD) often face burdensome end-of-life care transfers. Advanced practice clinicians (APCs)-which include nurse practitioners and physician assistants-increasingly provide primary care to this population. To fill current gaps in the literature, we measured the association between APC involvement in end-of-life care versus hospice utilization and hospitalization for older adults with ADRD.

Methods: Using Medicare data, we identified nursing home- (N=517,490) and community-dwelling (N=322,461) beneficiaries with ADRD who died between 2016 and 2018. We employed propensity score-weighted regression methods to examine the association between different levels of APC care during their final 9 months of life versus hospice utilization and hospitalization during their final month.

Results: For both nursing home- and community-dwelling beneficiaries, higher APC care involvement associated with lower hospitalization rates and higher hospice rates.

Discussion: APCs are an important group of providers delivering end-of-life primary care to individuals with ADRD.

Highlights: For both nursing home- and community-dwelling Medicare beneficiaries with ADRD, adjusted hospitalization rates were lower and hospice rates were higher for individuals with higher proportions of APC care involvement during their final 9 months of life. Associations between APC care involvement and both adjusted hospitalization rates and adjusted hospice rates persisted when accounting for primary care visit volume.

Keywords: Alzheimer's disease and related dementias; advanced practice clinicians; hospice utilization; hospital utilization; nurse practitioners; nursing home; physician assistants; primary care.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors have no conflicts of interest to disclose.

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