Advanced practice clinician care and end‐of‐life outcomes for community‐ and nursing home‐dwelling Medicare beneficiaries with dementia

Abstract

INTRODUCTIONOlder adults with Alzheimer's disease and related dementias (ADRD) often face burdensome end‐of‐life care transfers. Advanced practice clinicians (APCs)—which include nurse practitioners and physician assistants—increasingly provide primary care to this population. To fill current gaps in the literature, we measured the association between APC involvement in end‐of‐life care versus hospice utilization and hospitalization for older adults with ADRD.METHODSUsing Medicare data, we identified nursing home‐ (N=517,490) and community‐dwelling (N=322,461) beneficiaries with ADRD who died between 2016 and 2018. We employed propensity score‐weighted regression methods to examine the association between different levels of APC care during their final 9 months of life versus hospice utilization and hospitalization during their final month.RESULTSFor both nursing home‐ and community‐dwelling beneficiaries, higher APC care involvement associated with lower hospitalization rates and higher hospice rates.DISCUSSIONAPCs are an important group of providers delivering end‐of‐life primary care to individuals with ADRD.HIGHLIGHTS For both nursing home‐ and community‐dwelling Medicare beneficiaries with ADRD, adjusted hospitalization rates were lower and hospice rates were higher for individuals with higher proportions of APC care involvement during their final 9 months of life. Associations between APC care involvement and both adjusted hospitalization rates and adjusted hospice rates persisted when accounting for primary care visit volume.