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Use and cost of outpatient visits of AD patients: CERAD XXII

From the Center for the Study of Aging and Human Development (Dr. Fillenbaum and A. Weiman), the Division of Neurology (Dr. Heyman), and the Division of Biometry (Drs. Peterson and Pieper), Duke University Medical Center, Durham, NC.

Address correspondence and reprint requests to Dr. G. Fillenbaum, Box 3003, Duke University Medical Center, Durham, NC 27710; e-mail: ggf{at}geri.duke.edu

OBJECTIVE: To determine the probability, frequency, and cost of outpatient visits of patients with AD in the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) as a function of stage of dementia and institutional status.

METHODS: Clinical information on 388 patients with AD enrolled in CERAD who had no serious comorbidities at baseline and for whom the stage of disease and institutional status were known, were linked to Health Care Financing Administration Physician/Supplier and Outpatient Standard Analytic (institutional outpatient) files for 1991 through 1995. None was registered in a health maintenance organization. Repeated measures regression models were used to examine the relationship of stage of disease to probability, frequency, and cost of outpatient visits for institutionalized and noninstitutionalized patients, with demographic characteristics and calendar time controlled.

RESULTS: The annual proportion of patients with AD and a Medicare-reimbursed outpatient visit ranged from 81% to 95% and was not related to stage of dementia or institutional status. Among those with at least one outpatient visit, however, those living at home had fewer visits than did those in institutions, but their number of visits increased as dementia worsened. Those in institutions had a larger number of outpatient visits, but these did not vary significantly by stage of dementia. Neither location of residence nor stage affected the cost of outpatient visits.

CONCLUSION: Among those with an outpatient visit, the frequency of visits and their relationship to stage of disease depends on institutional status.

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