UTMB Researchers Set to Help Clinicians Diagnose Dementia Earlier

On July 28, 2023, a UTMB interprofessional research team received the 5-year, multi-PI R01 award notification ($2.8 million over five years) from the National Institute on Aging for their project “Annual wellness visit policy: Impact on disparities in early dementia diagnosis and quality of healthcare for Medicare beneficiaries with Alzheimer’s Disease and Its Related Dementias.” The 3 PIs of this interprofessional team have appointments in three UTMB Schools: Drs. Ming (Huey-Ming) Tzeng, (PI, School of Nursing, Professor), Yong-Fang Kuo (PI, School of Public and Population Health, Professor & Chair of the Statistics & Data Science Department, Health Service Researcher, and Biostatistician), and Mukaila Raji (PI, School of Medicine, Professor & Director of Geriatrics & Palliative Medicine Division, Geriatric Pharmacologist, and Dementia Specialist). An additional two Co-I are also from UTMB: Drs. Peter Cram (Co-I, School of Medicine, Professor & Chair, Internal Medicine), and Monique Pappadis (Co-I, School of Public and Population Health, Associate Professor of Population Health & Health Disparities).

Deborah J. Jones, Ph.D., MSN, RN, FAAN, Provost ad interim, Senior Vice President and Dean, School of Nursing, and Rebecca Sealy Distinguished Centennial Chair, congratulated the group, saying, "YOU DID IT!!!!!! This is fantastic news! I am thrilled for you all and appreciate the interprofessional collaboration and persistence of this group.”

Early recognition of cognitive impairment and timeliness in Alzheimer’s Disease and Related Dementias (ADRD) diagnosis are key to optimal dementia care. No studies have examined the effect of the annual wellness visit (AWV) policy on reducing disparities in ADRD diagnosis and health outcomes among community-dwelling Medicare beneficiaries with ADRD, based on the Institute for Healthcare Improvement (IHI) 4Ms framework of an age-friendly health system: "what matters," "mentation," "mobility," and "medication." This 5-year project will use this framework in a convergent parallel mixed-methods study to inform AWV policy and develop a practice guideline to improve the timeliness of ADRD diagnosis and post-diagnosis dementia care, thereby decreasing health disparities and improving quality of life among Medicare beneficiaries with ADRD.

The project is innovative in three key ways. First, it involves community participatory research collaboration with a national ADRD stakeholder and policy/care advocacy group — the Alzheimer's Association (AA) Houston & Southeast Texas Chapter and ADRD patients' family caregivers and clinicians — which allows rich access to the real-world opinions of a diverse group of caregivers, clinicians, dementia care specialists, policy experts, and AA members. Such opinions are critical in developing a patient-centered clinical practice guideline and in guiding ADRD-related policy.

Second, this study is the very first project using linkage multiple data sources to answer timely health disparity research questions related to older adults with ADRD. Using qualitative interview data along with three different datasets (Medicare claims, health retirement survey-Medicare linked data, and National Health & Aging Trends study-Medicare linked data) allows triangulation of data for consistency and validity in findings. The team includes experts with experience using various qualitative and quantitative methods (propensity score matching, inverse probability treatment weighting, and instrumental variable analyses) to control selection bias in observational data analyses.

Finally, as recommended by the AA, this study adopts IHI's 4Ms framework of an aging-friendly health system to examine the effect of an AWV policy on reducing health disparities using a convergent parallel mixed-methods design. The result will be earlier dementia diagnosis and more timely treatment to improve health and quality of life for patients and their families.