The Influence of Structural Capabilities on Hospitalizations Among Older Adults With Dementia

Currently, 6 million Americans have Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD). As the segment of Americans aged 65 and older continues to increase, the number of older adults with AD/ADRD (referred to as Persons Living with Dementia [PLWD]) also grows. Additionally, the use of health care services, such as hospitalizations, is increasing among PLWD. Indeed, hospitalizations are more prevalent among PLWD compared to older adults without dementia. Some of these hospitalizations are ambulatory care sensitive condition hospitalizations that can be prevented if individuals have better access to high-quality primary care. However, delivering high-quality primary care is becoming increasingly challenging given the projected PLWD population increase and the shortage of primary care providers. On the other hand, the number of primary care nurse practitioners who can deliver high-quality and cost-effective care to older adults has grown in recent years and will continue to increase with demand. Nonetheless, little is known about how to strengthen essential practice features (i.e., structural capabilities) needed to deliver high-quality care in practices where nurse practitioners provide care to PLWD. Enhancing primary care delivery by strengthening structural capabilities in primary care, such as electronic health records, care coordination, community integration, and reminder systems, can be an effective way to reduce hospitalizations among PLWD. The overall objective of this dissertation is to assess the effects of primary care structural capabilities in practices employing nurse practitioners on both ambulatory care sensitive conditions and all-cause hospitalizations among PLWD. This dissertation entails five chapters. Chapter 1 describes the significance of structural capabilities and related outcomes among PLWD. Chapter 2 includes a systematic review of existing dementia care models in various ambulatory care settings and summarizes the impact of dementia care models on hospitalizations among community-residing PLWD in the United States. Chapter 3 describes the availability of the selected structural capabilities in primary care practices where nurse practitioners provide care to PLWD. The structural capabilities of practices that provide care to a high volume of PLWD are also compared to those caring for a low volume of PLWD in this chapter. Chapter 4 assesses the impact of structural capabilities in primary care practices employing nurse practitioners on hospitalizations among PLWD. Finally, Chapter 5 summarizes the findings from Chapters 2 to 4 and includes information on the strengths, limitations, and implications of the research and findings of the dissertation