Dementia Coding, Workup, and Treatment in the VA New England Healthcare System

Area of Science:

• Neurology
• Gerontology
• Health Services Research

Background:

• Alzheimer's disease and dementia are increasingly recognized as significant public health concerns.
• Underdiagnosis and poor documentation of dementia hinder effective patient management and research.
• The Veteran's Administration (VA) healthcare system presents a unique setting to study dementia care patterns.

Purpose of the Study:

• To investigate patterns of dementia diagnosis coding and treatment within the Veteran's Administration New England Healthcare System.
• To identify disparities in dementia care based on healthcare provider type.
• To assess the documentation of cognitive impairment preceding dementia diagnoses.

Main Methods:

• Retrospective cohort study of 8,999 veterans diagnosed with dementia between 2002 and 2009.
• Analysis of outpatient ICD-9 codes for dementia and related cognitive impairments.
• Examination of healthcare utilization, medication use, neuroimaging, and provider type.

Main Results:

• Only 18.3% of veterans received a cognitive impairment code before their dementia diagnosis, often "memory loss".
• Two-thirds of initial dementia codes were assigned by Primary Care Providers (PCPs).
• Veterans managed solely by PCPs had reduced neuroimaging and dementia medication rates; specialists' patients had higher ER visits/hospitalizations.

Conclusions:

• Dementia diagnosis and documentation are often inadequate in the VA system, with a lack of documented prodromal symptoms.
• Veterans not seen by dementia specialists experience less comprehensive diagnostic assessment and treatment.
• Improved diagnostic coding and care coordination are crucial for optimizing dementia care in veteran populations.