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Changes in Medicare's Chronic Condition Files and Disparities in Dementia Identification
Rajesh Makineni1, Aaron Bloschichak1, Helena Temkin-Greener1
1Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Objectives:
In 2017, the Chronic Condition Warehouse released a 30-condition Chronic Condition file (CC30), which fully replaced the prior 27-condition file (CC27) in 2022. CC30 shortened the look-back period for dementia identification from 3 to 2 years and raised the required outpatient/carrier claims from 1 to 2. This change may disproportionately affect individuals with limited access to health care. This study aimed to quantify how the CC27-CC30 transition affects dementia identification across population subgroups.
Design:
Observational study.
Setting And Participants:
Medicare beneficiaries with dementia, including 12,951,241 person-years between 2018 and 2021.
Methods:
We linked 2018-2021 Medicare Beneficiary Summary Files (base file, CC27, and CC30) with publicly available data. Beneficiaries with Alzheimer's disease (AD) or Alzheimer's disease and related dementias (ADRD) in either CC27 or CC30 were identified. Disagreement was defined as having dementia in one file but not the other. Logistic regression was used to examine patient-level (eg, race/ethnicity, dual status, age, gender) and area-level (eg, mental health provider shortages, social deprivation) factors associated with the disagreement.
Results:
CC30 identified approximately 70% to 72% of AD and ADRD cases in CC27, and added very few additional ADRD cases (0.04%). Disagreement (mainly driven by the exclusion of individuals previously identified by CC27) varied by individual and community characteristics. For example, Asian and Hispanic beneficiaries had 51% to 55% and 20% to 26% higher odds of disagreement for ADRD, respectively (P < .01). Rural residence was associated with an 11% to 13% increase in the odds of disagreement of ADRD (P < .01). Residents in communities with higher socioeconomic deprivation and lower proportions of White residents also had a higher likelihood of disagreement in ADRD dementia identification.
Conclusions And Implications:
Transitioning from CC27 to CC30 reduces identified AD and ADRD dementia cases, disproportionately affecting certain subpopulations. Researchers and policymakers should consider these changes when interpreting trends and designing dementia care interventions.
Insights
The Chronic Condition Warehouse
Area of Science:
- Gerontology
- Public Health
- Health Services Research
Background:
- The Chronic Condition Warehouse (CCW) updated its Chronic Condition file from a 27-condition (CC27) to a 30-condition (CC30) version in 2022.
- The CC30 file introduced changes to dementia identification criteria, including a shortened look-back period and increased claim requirements.
- These modifications may impact the identification of dementia cases, particularly among vulnerable populations.
Purpose of the Study:
- To quantify the impact of the CC27 to CC30 transition on dementia identification across diverse demographic and geographic subgroups.
- To examine individual-level factors (race/ethnicity, dual status, age, gender) and area-level factors (provider shortages, social deprivation) associated with dementia identification discrepancies.
- To assess the effect of updated CCW data on Alzheimer's disease (AD) and Alzheimer's disease and related dementias (ADRD) case identification.
Main Methods:
- An observational study utilizing Medicare Beneficiary Summary Files (2018-2021) linked with publicly available data.
- Identification of beneficiaries with AD or ADRD using both CC27 and CC30 criteria.
- Logistic regression analysis to determine factors associated with disagreement in dementia identification between CC27 and CC30.
Main Results:
- The CC30 file identified only 70-72% of AD and ADRD cases previously identified by CC27, adding minimal new cases (0.04%).
- Discrepancies in dementia identification were significantly associated with patient and community characteristics.
- Asian and Hispanic beneficiaries, rural residents, and those in socioeconomically deprived areas showed higher odds of disagreement in ADRD identification.
Conclusions:
- The transition from CC27 to CC30 led to a reduction in identified AD and ADRD cases, disproportionately affecting specific subpopulations.
- These changes necessitate careful consideration by researchers and policymakers when interpreting dementia trends and developing care interventions.
- The findings highlight potential disparities in dementia identification due to data update modifications.
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