Can continuity of care reduce hospitalization among community-dwelling older adult veterans living with dementia?

Lei, Lianlian; Cai, Shubing; Conwell, Yeates; Fortinsky, Richard H.; Intrator, Orna

doi:10.1097/mlr.0000000000001386

Cited by 15Primary Care and Health OutcomesDementia and Cognitive Impairment ResearchGeriatric Care and Nursing Homes

Can continuity of care reduce hospitalization among community-dwelling older adult veterans living with dementia?

Lei, Lianlian, Cai, Shubing, Conwell, Yeates, Fortinsky, Richard H., Intrator, Orna·2020·Medical Care

DOI 10.1097/mlr.0000000000001386

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Abstract

BACKGROUND: Hospitalization is a difficult experience, especially for patients with dementia. Understanding whether better continuity of care (COC) reduces hospitalizations can indicate interventions that might help curb hospitalizations. OBJECTIVE: To estimate the causal impact of COC on hospitalizations and different reasons for hospitalization among community-dwelling older veterans with dementia. RESEARCH DESIGN: Population-based observational study using nationwide Veterans Health Administration data linked to Medicare claims in Fiscal Years (FYs) 2014-2015. To account for unobserved confounders we used an instrumental variable for COC-whether veteran changed residence by more than 10 miles. SUBJECTS: Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (n=105,528). MEASURES: Bice-Boxerman Continuity of Care (BBC) index (0-worst to 1-best COC); binary indicators of any hospitalization for all causes, for ambulatory care sensitive conditions (ACSCs) and for reasons grouped by major diagnostic category. RESULTS: The mean BBC in FY 2014 was 0.32 (SD, 0.23). In FY 2015 43.3% of the cohort veterans were hospitalized. A 0.1 higher BBC resulted in 2.4% (95% confidence interval, 0.5%-4.4%) lower probability of hospitalization for all causes. BBC was not associated with hospitalization for ACSCs. Grouped by major diagnostic category, a 0.1 higher BBC resulted in 3.8% (95% confidence interval, 2.1%-5.4%) lower probability of hospitalization for neuropsychiatric diseases/disorders, with no impact on hospitalizations for circulatory, respiratory, infectious, kidney and urinary, digestive, musculoskeletal, and endocrine-metabolic diseases/disorders. CONCLUSIONS: Among community-dwelling older veterans with dementia, better COC resulted in less hospitalizations, and this effect was primarily due to less hospitalization for neuropsychiatric diseases/disorders but not hospitalization for ACSCs, or other hospitalization reasons.

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“Ongoing relationships with general practitioners built trust, promoted earlier identification of support needs, and were associated with lower rates of emergency hospitalization and delirium (Delgado et al., 2022; Godard-Sebillotte et al., 2021; Lei et al., 2020; Nguyen et al., 2022; Toles et al., 2022b; Zmora et al., 2021).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Lei et al., 2020
Ongoing relationships with general practitioners built trust and promoted earlier identification of support needs.
“Ongoing relationships with general practitioners built trust, promoted earlier identification of support needs, and were associated with lower rates of emergency hospitalization and delirium (Delgado et al., 2022; Godard-Sebillotte et al., 2021; Lei et al., 2020; Nguyen et al., 2022; Toles et al., 2022b; Zmora et al., 2021).”
From Mind the gap: a systematic review of barriers, facilitators, and experiences of care transitions for people living with dementia and their informal caregivers. (2026) · cites this paper as Lei et al., 2020

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Authors: Lei, L., Cai, S., Conwell, Y., Fortinsky, R. H., & Intrator, O.
Affiliations: University of Michigan (US)
University of Rochester Medicine (US)
University of Connecticut (US)
Corresponding author: Lei, Lianlian
ORCID: Lei, Lianlian
Cai, Shubing
Conwell, Yeates
Fortinsky, Richard H.
Intrator, Orna
Venue: Medical Care
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2020-09-10
Volume: 58
Issue: 11
Pages: 988-995
ISSN: 0025-7079 (ISSN-L)
DOI: 10.1097/mlr.0000000000001386
OpenAlex: W3086282682
Cited by: 15
References: 46
Citations by year: 2025: 6 · 2024: 4 · 2023: 1 · 2022: 3 · 2021: 1
FWCI: 1.30
Type: journal article
Language: en
Open access: closed
Locations: Medical Care (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
Keywords: continuity of care, hospitalization, dementia, older veterans, community-dwelling older adults, ambulatory care sensitive conditions, neuropsychiatric disorders, Medicare, Veterans Health Administration
MeSH terms: Aged, Aged, 80 and over, Continuity of Patient Care, Dementia, Female, Medicare, Hospitalization, Humans, Male, Retrospective Studies, United States, Veterans, Independent Living

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Can continuity of care reduce hospitalization among community-dwelling older adult veterans living with dementia?

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