Improving Medication Use and Outcomes in Older Adults with Dementia after Hospitalization: Effectiveness of Medicare Programs

PROJECT SUMMARY/ABSTRACT Hospitalizations and medication problems after discharge are a major risk factor for poor health outcomes in older adults with Alzheimer's disease and related dementia (ADRD). Increased preventable medication problems, such as unnecessary continuation of medications with neurocognitive adverse effects, emergency

department visits, readmissions, and costs after hospitalization are a significant burden for older adults with ADRD. A better understanding of how patient and healthcare factors contribute to use of medications with neurocognitive effects and poor outcomes after hospitalization will inform policies to improve medication-

related outcomes and care transitions in older adults with ADRD. This K08 Mentored Clinical Scientist Research Career Development Award application (PA-20-203) is to support Antoinette B. Coe, PharmD, PhD, a pharmacist-scientist and Assistant Professor in the University of Michigan College of Pharmacy. Dr. Coe's

long-term goal is to become an independent investigator advancing the science of medication use in aging with a research program demonstrating ways to ensure safe and effective medication use in older adults, especially those who are vulnerable, cognitively impaired, and have ADRD. To achieve this goal, Dr. Coe will carry out

the scientific aims of this proposal along with a robust career development plan in which she will acquire content expertise in cognitive impairment, ADRD, and aging, gain advanced epidemiology statistics training including causal inference methods, and develop an understanding of health and public policy impact on

ADRD outcomes. The overarching scientific goal of this mentored-research proposal is to understand how poor outcomes related to medications with neurocognitive effects after a hospitalization can be mitigated in older adults with ADRD. This proposal leverages two existing Medicare care programs and payment policies that

include medication reviews as potential solutions to reduce inappropriate neurocognitive medication use after care transitions: Medicare Part D Comprehensive Medication Reviews (CMR) and Part B Transitional Care Management (TCM) visits. Using nationally representative Medicare administrative data, the specific aims are

as follows: 1) Identify predictors of inappropriate neurocognitive medication use in older adults with ADRD after hospitalization, 2) Examine the use of medication reviews (both CMR and TCM) among older adults who have been hospitalized and assess factors associated with their use, and 3) Test the effectiveness of

comprehensive medication reviews and transitional care management on outcomes in older adults with ADRD after hospitalization. Dr. Coe will conduct all work at the rich environment of the University of Michigan, with an exceptional mentoring and advisory team led by Dr. Julie Bynum. The study's results will inform a large-scale

R01-level application testing strategies to increase medication reviews in older adults with ADRD and their caregivers and motivate Medicare policy changes to ensure safe medication use in older adults with ADRD.