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One‐Year Effect of the Medicare Annual Wellness Visit on Detection of Cognitive Impairment: A Cohort Study
Author(s) -
Fowler Nicole R.,
Campbell Noll L.,
Pohl Gerhardt M.,
Munsie Leanne M.,
Kirson Noam Y,
Desai Urvi,
Trieschman Erich J.,
Meiselbach Mark K.,
Andrews J. Scott,
Boustani Malaz A.
Publication year - 2018
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.15330
Subject(s) - medicine , dementia , cohort , cognition , gerontology , cohort study , ambulatory , retrospective cohort study , medical diagnosis , alzheimer's disease , pediatrics , disease , physical therapy , psychiatry , pathology
Objectives To examine the effect of the Medicare Annual Wellness Visit (AWV) on the detection of cognitive impairment and on follow‐up cognitive care for older adults. Design Retrospective matched‐cohort study. Setting United States. Participants A 5% random sample of fee‐for‐service Medicare beneficiaries continuously enrolled for 12 months before and after an index ambulatory visit occurring from 2011 to 2013 with no claims evidence of cognitive impairment before index. Measurements Outcomes include 12‐month post‐index visit claims‐based measurements of cognitive impairment, including new Alzheimer's disease and related dementia (ADRD) diagnoses; medications for ADRD; and cognitive care‐related diagnostic examination such as neurobehavioral testing, brain imaging, and blood tests for thyroid‐stimulating hormone (TSH), serum B12, folate, and syphilis. We also measured changes in burden of anticholinergic medication. Results There were no clinically relevant differences between the AWV and control groups in the rates of incident ADRD diagnoses (6.16% vs 6.86%, p<.001) and initiation of ADRD medications (1.00% vs 1.08%, p=.15), although there were differences favoring the AWV group in rates of TSH (39.80% vs 28.36%, p<.001), B12 (9.41% vs 6.97%, p<.001), folate (4.76% vs 3.72%, p<.001), and neurobehavioral (0.75% vs 0.55%, p<.001) testing. Conclusions Although the AWV is correlated with an increase in some measures of cognitive care, such as laboratory testing for reversible causes of cognitive impairment, it does not appear to substantially increase recognition of undetected ADRD.