Table 1. Characteristics of Medicare Fee-for-Service Beneficiaries Enrolled in Medicare Shared Savings Program Accountable Care Organization Aged 65 Years and Older With Alzheimer Disease and Related Dementias by Race and Ethnicity.
| Characteristicc | CAHPS score, mean (SD)a,b | P valued | |||
|---|---|---|---|---|---|
| African American or Black (n = 38 030) | Asian (n = 6258) | Hispanic (n = 18 231) | Non-Hispanic White (n = 505 849) | ||
| Age, y | <.001 | ||||
| 65-74 | 0.22 (0.41) | 0.20 (0.40) | 0.21 (0.41) | 0.15 (0.36) | |
| 75-84 | 0.37 (0.48) | 0.35 (0.48) | 0.37 (0.48) | 0.35 (0.48) | |
| ≥85 | 0.33 (0.47) | 0.37 (0.48) | 0.35 (0.48) | 0.42 (0.49) | |
| Sex | <.001 | ||||
| Male | 0.36 (0.48) | 0.4 (0.49) | 0.4 (0.49) | 0.39 (0.49) | |
| Female | 0.64 (0.48) | 0.6 (0.49) | 0.6 (0.49) | 0.61 (0.49) | |
| Chronic conditions | |||||
| Acute myocardial infarction | 0.01 (0.11) | 0.01 (0.09) | 0.01 (0.11) | 0.01 (0.1) | <.001 |
| Asthma | 0.06 (0.24) | 0.05 (0.22) | 0.06 (0.24) | 0.05 (0.21) | <.001 |
| Atrial fibrillation | 0.08 (0.27) | 0.09 (0.29) | 0.10 (0.3) | 0.17 (0.37) | <.001 |
| Heart failure | 0.27 (0.44) | 0.17 (0.38) | 0.23 (0.42) | 0.24 (0.43) | <.001 |
| Chronic obstructive pulmonary disease | 0.13 (0.33) | 0.08 (0.28) | 0.12 (0.32) | 0.16 (0.36) | <.001 |
| Depression | 0.22 (0.42) | 0.24 (0.43) | 0.3 (0.46) | 0.33 (0.47) | <.001 |
| Diabetes | 0.47 (0.5) | 0.42 (0.49) | 0.47 (0.5) | 0.29 (0.45) | <.001 |
| Hyperlipidemia | 0.58 (0.49) | 0.58 (0.49) | 0.61 (0.49) | 0.57 (0.5) | <.001 |
| Hypertension | 0.85 (0.36) | 0.71 (0.45) | 0.76 (0.42) | 0.74 (0.44) | <.001 |
| Stroke/transient ischemic attack | 0.11 (0.31) | 0.09 (0.28) | 0.09 (0.29) | 0.09 (0.29) | <.001 |
| Rural vs urban status | <.001 | ||||
| Rural | 0.03 (0.17) | 0.01 (0.09) | 0.07 (0.26) | 0.03 (0.18) | |
| Nonmetropolitan | 0.07 (0.25) | 0.03 (0.16) | 0.06 (0.23) | 0.15 (0.35) | |
| Urban | 0.90 (0.30) | 0.96 (0.19) | 0.87 (0.33) | 0.82 (0.38) | |
| Zip-code level, % | |||||
| High school degree and higher | 86.00 (7.55) | 90.35 (7.60) | 83.71 (11.78) | 90.28 (6.38) | <.001 |
| Poverty | 18.62 (10.45) | 10.52 (6.93) | 15.77 (9.68) | 11.62 (7.13) | <.001 |
| Black | 41.06 (28.83) | 9.57 (12.54) | 9.57 (13.01) | 8.65 (12.1) | <.001 |
| Whole county mental health shortage area | 0.17 (0.37) | 0.09 (0.29) | 0.24 (0.43) | 0.26 (0.44) | <.001 |
| Area Deprivation Index >50th percentile | 0.63 (0.48) | 0.24 (0.42) | 0.56 (0.50) | 0.50 (0.50) | <.001 |
Sample size: Our study focused on patients who had a diagnosis of Alzheimer disease and related dementias, using the measure of the CMS Chronic Conditions Data Warehouse. The sample was limited to community-based fee-for-service (at least 12 months) beneficiaries aged 65 years and older. Medicare Advantage and dual-eligible beneficiaries were excluded from the analysis (1 654 646 beneficiaries). Our study focused on African American or Black, Asian, Hispanic, and White patients (1 630 414 beneficiaries). Patients were linked to the ACO beneficiary level file shared savings program (591 920 beneficiaries). Our study focused on the observations with all the 6 ACO CAHPS measures (576 583 beneficiaries). The resulting sample for the analysis included 568 368 beneficiaries after dropping the observations with missing measures of Area Deprivation Index.
All the variables from age to urban are dummy variables.
We used the 2017 Centers for Medicare & Medicaid Services (CMS) Medicare inpatient claims data and Medicare Beneficiary Summary File (MBSF). We further linked the CMS MBSF with the 2017 Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) data to capture ACO characteristics. We used the ACO Consumer Assessment of Healthcare Providers and Systems (CAHPS) evaluations reported by the CMS 2017 ACO Quality Reporting Documentation.18
Tests were used to test the mean differences of 4 racial and ethnic groups. χ2 tests were used for categorical variables. Analysis of variance tests were used for continuous variables.