The Effects of Dementia Care Co‐Management on Acute Care, Hospice, and Long‐Term Care Utilization
Open accessAbstract
BACKGROUND/OBJECTIVES: Although nurse practitioner dementia care co-management has been shown to reduce total cost of care for fee-for-service (FFS) Medicare beneficiaries, the reasons for cost savings are unknown. To further understand the impact of dementia co-management on costs, we examined acute care utilization, long-term care admissions, and hospice use of program enrollees as compared with persons with dementia not in the program using FFS and managed Medicare claims data. DESIGN: Quasi-experimental controlled before-and-after comparison. SETTING: Urban academic medical center. PARTICIPANTS: A total of 856 University of California, Los Angeles (UCLA) Alzheimer's and Dementia Care program patients were enrolled between July 1, 2012, and December 31, 2015, and 3,139 similar UCLA patients with dementia not in the program. Comparison patients were identified as having dementia using International Classification of Diseases-9 codes and natural language processing of clinical notes. Coarsened exact matching was used to reduce covariate imbalance between intervention and comparison patients. INTERVENTION: Dementia co-management model using nurse practitioners partnered with primary care providers and community organizations. MEASUREMENTS: Average difference-in-differences per quarter over the 2.5-year intervention period for all-cause hospitalization, emergency department (ED) visits, intensive care unit (ICU) stays, and number of inpatient hospitalization days; admissions to long-term care facilities; and hospice use in the last 6 months of life. RESULTS: Intervention patients had fewer ED visits (odds ratio [OR] = .80; 95% confidence interval [CI] = .66-.97) and shorter hospital length of stay (incident rate ratio = .74; 95% CI = .55-.99). There were no significant differences between groups for hospitalizations or ICU stays. Program participants were less likely to be admitted to a long-term care facility (hazard ratio = .65; 95% CI = .47-.89) and more likely to receive hospice services in the last 6 months of life (adjusted OR = 1.64; 95% CI = 1.13-2.37). CONCLUSION: Comprehensive nurse practitioner dementia care co-management reduced ED visits, shortened hospital length of stay, increased hospice use, and delayed admission to long-term care.
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The Dementia Care Co-Management Model embedded care managers and comprehensive planning tools to proactively manage transitions and reduce avoidable hospital admissions.
“The Dementia Care Co-Management Model, for example, embedded care managers and comprehensive planning tools to proactively manage transitions and reduce avoidable hospital admissions (Jennings et al., 2020).”
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 Jennings et al., 2020
The Description of the Clinical Program describes nurse practitioner dementia care specialists and individualized care plans, and the Discussion explains how specialists may facilitate discharge after hospitalization. But the paper reports no significant reduction in hospitalizations, so it does not support the claim that the model reduced avoidable hospital admissions. Page numbers are unavailable in our copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredInconsistent referral criteria and service availability across geographical regions contributed to inequitable access to transitional care support.
“Furthermore, studies highlighted that inconsistent referral criteria and service availability across geographical regions contributed to inequitable access to transitional care support (de Vries et al., 2019; Eyles et al., 2021; Jennings et al., 2020; Kupeli et al., 2019; Parker et al., 2021; Pond et al., 2019).”
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 Jennings et al., 2020
The Discussion (page not available) says the study examined patients within one health system and lacked information about referring-provider characteristics that might affect program referral. The searched passages do not address inconsistent referral criteria, regional differences in service availability, or inequitable access to transitional care support. (LLM, conf=0.75)
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- Authors
- Jennings, L. A., Hollands, S., Keeler, E., Wenger, N. S., & Reuben, D. B.
- Affiliations
- University of Oklahoma Health Sciences Center (US)
- RAND Corporation (US)
- University of California, Los Angeles (US)
- Corresponding author
- Reuben, David B.
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2020-06-23
- Volume
- 68
- Issue
- 11
- Pages
- 2500-2507
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W3037733837
- Cited by
- 46
- References
- 25
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 9 · 2023: 6 · 2022: 6 · 2021: 7 · 2020: 1
- FWCI
- 3.65
- Type
- journal article
- Language
- en
- Open access
- green
- escholarship.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Alzheimer's Association (New Investigator Research Grant / 15‐364406)
- Centers for Medicare and Medicaid Services (HHSM 500‐2011‐00002I Task Order HHSM‐500‐T0009, HHSM‐500‐T0009, HHSM 500‐2011‐00002I)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Keywords
- nurse practitioners, acute care utilization, emergency department visits, length of hospital stay, long-term care admission, hospice use, Medicare beneficiaries, managed care, cost reduction, primary care partnerships
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Comprehensive Health Care, Emergency Service, Hospital, Female, Hospitalization, Humans, Intensive Care Units, Length of Stay, Male, Primary Health Care, Hospice Care, Advanced Practice Nursing, Practice Patterns, Nurses', Controlled Before-After Studies
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