TABLE 1.
Characteristics of patients with incident Alzheimer's disease and related dementia (ADRD) codes in 2020 compared to 2017–2019
| 2017 | 2018 | 2019 | 2020 | 2020 | |||
|---|---|---|---|---|---|---|---|
| At risk members aged 65 years and older | 527,727 | 558,252 | 585,980 | 610,892 | Face‐to‐face | Phone | Video |
| Incident ADRD codes 95%CI |
7568 (1.43%) 1.40–1.47% |
7872 (1.41%) 1.38–1.44% |
7976 (1.36%) 1.33–1.39% |
7950 (1.30%) 1.27–1.33% |
(n = 2298) | (n = 1130) | (n = 472) |
| Age | 82.2 (7.60) | 82.2 (7.59) | 82.3 (7.71) | 82.2 (7.69) | 80.9 (7.11) | 82.2 (7.85) | 82.5 (7.40) |
| 65–74 | 1344 (17.8%) | 1375 (17.5%) | 1414 (17.7%) | 1434 (18%) | 477 (20.8%) | 201 (17.8%) | 78 (16.5%) |
| 75–84 | 3186 (42.1%) | 3343 (42.5%) | 3341 (41.9%) | 3280 (41.3%) | 1057 (46%) | 464 (41.1%) | 198 (41.9%) |
| ≥85 | 3038 (40.1%) | 3154 (40.1%) | 3221 (40.4%) | 3236 (40.7%) | 764 (33.2%) | 465 (41.2%) | 196 (41.5%) |
| Female | 4373 (57.8%) | 4524 (57.5%) | 4681 (58.7%) | 4465 (56.2%) | 1312 (57.1%) | 661 (58.5%) | 307 (65%) |
| Race/ethnicity | |||||||
| White | 4241 (56%) | 4257 (54.1%) | 4320 (54.2%) | 4142 (52.1%) | 1161 (50.5%) | 576 (51%) | 207 (43.9%) |
| Asian/Pacific Islander | 608 (8%) | 679 (8.6%) | 696 (8.7%) | 671 (8.4%) | 209 (9.1%) | 90 (8%) | 54 (11.4%) |
| Black | 967 (12.8%) | 1000 (12.7%) | 1000 (12.5%) | 1097 (13.8%) | 286 (12.4%) | 151 (13.4%) | 70 (14.8%) |
| Hispanic | 1685 (22.3%) | 1836 (23.3%) | 1858 (23.3%) | 1950 (24.5%) | 612 (26.6%) | 294 (26%) | 138 (29.2%) |
| Multiple/Other/Unknown | 67 (0.9%) | 100 (1.3%) | 102 (1.3%) | 90 (1.1%) | 30 (1.3% | 19 (1.7%) | 3 (0.6%) |
| Non‐English speaking, requires an interpreter | 777 (10.3%) | 822 (10.4%) | 848 (10.6%) | 915 (11.5%) | 317 (13.8%) | 142 (12.6%) | 66 (14%) |
| Encounter type | |||||||
| Internal encounters | 6315 (83.4%) | 6469 (82.2%) | 6436 (80.7%) | 6184 (77.8%) | |||
| Face‐to‐face | 3597 (57%) | 3655 (56.5%) | 3760 (58.4%) | 2298 (37.2%) | ‐ | ‐ | ‐ |
| Phone | 234 (3.7%) | 336 (5.2%) | 410 (6.4%) | 1130 (18.3%) | ‐ | ‐ | ‐ |
| Video | 3 (0%) | 3 (0%) | 5 (0.1%) | 472 (7.6%) | ‐ | ‐ | ‐ |
| Geriatrics/Neurology/Psychiatry a | 2457 (64.1%) | 2506 (62.7%) | 2604 (62.4%) | 2205 (56.5%) | 1409 (61.3%) | 450 (39.8%) | 346 (73.3%) |
| Primary care a | 1290 (33.6%) | 1377 (34.5%) | 1468 (35.2%) | 1588 (40.7%) | 846 (36.8%) | 625 (55.3%) | 117 (24.8%) |
| Other specialties a | 87 (2.3%) | 111 (2.8%) | 103 (2.5%) | 107 (2.7%) | 43 (1.9%) | 55 (4.9%) | 9 (1.9%) |
| Hospital‐based (ED/Obs/Inpatient) | 2253 (35.7%) | 2404 (37.2%) | 2225 (34.6%) | 2246 (36.3%) | ‐ | ‐ | ‐ |
| Continuing care: Home/SNF/LTC | 228 (3.6%) | 71 (1.1%) | 36 (0.6%) | 38 (0.6%) | ‐ | ‐ | ‐ |
| External encounters b | 1253 (16.6%) | 1403 (17.8%) | 1540 (19.3%) | 1766 (22.2%) | ‐ | ‐ | ‐ |
| Any cognitive assessment c | 1384 (34.1%) | 1433 (35.3%) | 1632 (38.8%) | 1296 (32.9%) | 1008 (43.9%) | 130 (11.5%) | 156 (33.1%) |
| MOCA, n% | 515 (12.7%) | 578 (14.2%) | 680 (16.1%) | 562 (14.3%) | 461 (20.1%) | 59 (5.2%) | 41 (8.7%) |
| mean (SD) | 15.7 (5.23) | 15.4 (5.55) | 15.6 (6.08) | 16.1 (6.38) | 15.9 (6.44) | 16.6 (5.76) | 17.1 (6.55) |
| SLUMS, n% | 112 (2.8%) | 171 (4.2%) | 288 (6.8%) | 272 (6.9%) | 233 (10.1%) | 6 (0.5%) | 33 (7%) |
| mean (SD) | 14.1 (5.95) | 13.0 (4.94) | 12.8 (5.53) | 12.8 (5.21) | 12.9 (5.03) | 12.7 (7.74) | 12.5 (6.05) |
| MMSE, n% | 834 (20.5%) | 796 (19.6%) | 770 (18.3%) | 595 (15.1%) | 413 (18%) | 77 (6.8%) | 104 (22%) |
| mean (SD) | 20.2 (5.74) | 20.1 (5.77) | 19.5 (6.07) | 19.2 (6.59) | 19.2 (6.39) | 18.8 (6.98) | 19.2 (6.95) |
| FAST staging, n% d | 3 (0.1%) | 74 (1.8%) | 818 (19.4%) | 701 (17.8%) | 484 (21.1%) | 66 (5.8%) | 150 (31.8%) |
| mean (SD) | 4.3 (0.58) | 4.8 (1.13) | 4.5 (0.82) | 4.4 (0.79) | 4.3 (0.70) | 4.6 (0.92) | 4.6 (0.92) |
Note: Data are presented as n(%) or mean(SD).
Abbreviations: ED, emergency department; LTC, long‐term care; MMSE, Mini‐Mental Status Exam; MoCA, Montreal Cognitive Assessment; Obs, observation stay; SNF, skilled nursing facility; SLUMS, St Louis University Mental Status Exam.
Only outpatient (face‐to‐face, phone, video) encounters within Kaiser Permanente.
A majority (81%) of the encounters external to Kaiser Permanente were for hospital‐based care.
Cognitive assessments completed during non‐ED/hospital encounters.
FAST was officially adopted by geriatrics in 2019.