Dementia patients with low continuity of care have higher health costs


Dementia patients with a higher continuity of care tend to have significantly lower overall healthcare costs, according to a new study in JAMA Internal Medicine.

The study followed a fee-for-service Medicare population of more than 1.4 million patients who had at least four ambulatory care visits in calendar 2012.

Those with a higher continuity of care had a mean of 10.5 visits with 2.5 clinicians. Those with a lower continuity of care experience a mean of 15.6 visits with 7.1 clinicians. Nearly half of the entire population had at least one hospitalization during the year of study.

Those patients with a lower continuity of care had healthcare costs of $24,371, more than 11 percent higher than those with a higher continuity of care ($22,004). Those with lower continuity of care were also more likely to visit a hospital emergency room, be admitted to a hospital, undergo pricey CT scans to the head, and undergo urinalysis tests, among other cost drivers.

One surprise in the study: Those dementia patients with a lower continuity of care tended to be younger and had higher incomes than those with higher care continuity.

Dementia care is already one of the costliest issues in healthcare delivery. The average patient cost approaches $300,000 for a lifetime, far more than the cost of treating heart disease or cancer. That hospital patients with dementia are also more likely to be the victim of medical errors tends to drive up their costs further. That's likely because many hospitals do not label patients as having dementia during their stays, leading to communication gaps that can cause care issues.

“When considering differences in healthcare spending per beneficiary, individuals with the most fragmented care are associated with an additional $567 million to $1.1 billion in healthcare spending compared with those with medium or high continuity,” the study found.

- read the study abstract