A Comparison of Measures for Identifying Possible Dementia in Veterans Affairs Nursing Home Residents

IF 3.8 2区医学 Q2 GERIATRICS & GERONTOLOGY Journal of the American Medical Directors Association Pub Date : 2025-02-07 DOI:10.1016/j.jamda.2024.105481

Joshua D. Niznik PharmD, PhD , Florentia E. Sileanu MS , Xinhua Zhao PhD , Kelvin Tran PharmD, MPS , Laura C. Hanson MD, MPH , Alan Kinlaw PhD , Thomas R. Radomski MD, MS , Alexa Ehlert MS , Sydney Springer PharmD, MS , Binxin Cao PharmD, MPH , Loren J. Schleiden MS , Carolyn T. Thorpe PhD, MPH

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Abstract

Objectives

Identifying people with possible dementia in health care systems is important to study outcomes and target improvements in care. This study sought to compare the performance of diagnostic codes and Minimum Data Set (MDS)-based measures for identifying dementia and cognitive impairment in older veteran nursing home residents.

Design

Retrospective, cross-sectional analysis.

Setting and Participants

We used real-world health care data from the Veterans Affairs (VA) Residential History File, VA Corporate Data Warehouse (CDW), Medicare claims, and the MDS to assemble a cohort of VA Community Living Center (CLC) admissions over 2015 to 2021 for veterans aged ≥ 65 with dual VA and Medicare enrollment (n = 54,234).

Methods

We defined 3 measures of possible dementia: (1) claims/CDW diagnoses using Chronic Conditions Warehouse (CCW) algorithms for Alzheimer’s disease or non-Alzheimer’s dementia; (2) MDS active diagnosis items for Alzheimer’s disease and non-Alzheimer’s dementia; and (3) MDS Cognitive Function Scale (CFS) assessment indicating at least mild cognitive impairment. We calculated proportions identified with each definition, and sensitivity, specificity, and positive predictive value of claims/CDW diagnoses and MDS indicators for dementia for identifying CFS impairment.

Results

Among VA CLC residents, 61.4% met at least 1 criterion for possible dementia (38.6% claims/CDW, 23.3% MDS active diagnosis, 50.8% CFS). Diagnoses from claims/CDW had 56.5% sensitivity and 80.0% specificity for identifying veterans with CFS cognitive impairment. Active diagnoses from the MDS exhibited poorer sensitivity (38.1%), but higher specificity (92.0%) identifying veterans with cognitive impairment on the CFS.

Conclusions and Implications

Consistent with what has been reported in Medicare nursing home residents, we observed only partial overlap between indicators of possible dementia across diagnosis codes and other indicators vs cognitive assessments in MDS. Our findings support the utility of these measures for identifying individuals with possible dementia across different systems, but further work is needed to understand implications when using diagnosis codes or cognitive assessments.

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退伍军人事务养老院居民可能痴呆的识别方法比较

目的：在卫生保健系统中识别可能患有痴呆症的人对于研究结果和目标改善护理非常重要。本研究旨在比较诊断代码和基于最小数据集（MDS）的措施在老年退伍军人养老院居民中识别痴呆和认知障碍的性能。设计：回顾性、横断面分析。背景和参与者：我们使用来自退伍军人事务（VA）居住历史档案、VA企业数据仓库（CDW）、医疗保险索赔和MDS的真实医疗保健数据，收集了2015年至2021年退伍军人社区生活中心（CLC）入院的≥65岁退伍军人社区生活中心和医疗保险双重登记（n = 54,234）。方法：我们定义了3种可能的痴呆测量方法：(1)使用慢性疾病仓库（CCW）算法对阿尔茨海默病或非阿尔茨海默病痴呆进行索赔/CDW诊断；(2) MDS对阿尔茨海默病和非阿尔茨海默病痴呆的主动诊断项目；(3) MDS认知功能量表（CFS）评估，至少显示轻度认知障碍。我们计算了每个定义确定的比例，以及索赔/CDW诊断和MDS指标对识别CFS损害的痴呆的敏感性、特异性和阳性预测值。结果：在VA CLC患者中，61.4%至少符合1项可能的痴呆标准（38.6%声称/CDW， 23.3% MDS积极诊断，50.8% CFS）。根据claim /CDW诊断CFS认知障碍的敏感性为56.5%，特异性为80.0%。MDS的主动诊断表现出较差的敏感性（38.1%），但较高的特异性（92.0%）识别CFS认知障碍退伍军人。结论和意义：与在医疗保险养老院居民中报道的一致，我们观察到MDS中诊断代码和其他指标与认知评估之间可能的痴呆指标之间只有部分重叠。我们的研究结果支持这些措施在不同系统中识别可能患有痴呆症的个体的效用，但需要进一步的工作来了解使用诊断代码或认知评估时的含义。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Medical Directors Association 医学-老年医学

CiteScore

11.10

自引率

6.60%

发文量

472

审稿时长

44 days

期刊介绍： JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates. The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality