Publications

Observational study of patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment without dementia

Timely diagnosis of cognitive impairment is a key goal of the National Plan to Address Alzheimer's Disease, but studies of factors associated with a timely diagnosis are limited. This study is to identify patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment (MCI).

White L, Ingraham B, Larson E, Fishman P, Park S, Coe NB: Observational Study of Patient Characteristics Associated with a Timely Diagnosis of Dementia and Mild Cognitive Impairment without Dementia. Journal of General Internal Medicine 37(12): 2957-2965, Sep 2022.

Association of Medicare Advantage star ratings with patterns of end-of-life care

No abstract available

Park S, Teno JM, White L, Coe NB: Association of Medicare Advantage star ratings with patterns of end-of-life care. Journal of the American Geriatrics Society Sep 2022 Notes: Online ahead of print.

Paid Care Services and Transitioning Out of the Community among Black and White Older Adults with Dementia

Paid care provided in the home includes important support services for older adults with dementia such as cleaning and personal care assistance. By reducing unmet needs, these services could delay the transition to residential long-term care, but access may differ across racial groups. This study examined the relationship between paid care and transitioning out of the community among Black and White older adults with dementia.

Roche-Dean M, Baik S, Moon H, Coe NB, Oh A, Zahodne LB: Paid Care Services and Transitioning Out of the Community among Black and White Older Adults with Dementia. The journals of gerontology. Series B, Psychological sciences and social services Sep 2022 Notes: Online ahead of print.

Growth of Private Pay Senior Housing Communities in Metropolitan Statistical Areas in the United States: 2015-2019

Older adults needing assistance with activities of daily living can receive support in various settings. Senior housing communities, such as independent living, assisted living, and continuing care retirement communities, are an increasingly popular option for adults not requiring nursing home-level care. However, limited research exists due to a dearth of data on these types of communities. We use a proprietary data set to describe the market of private pay senior housing and community-level characteristics in 140 metropolitan statistical areas, from 2015 to 2019. Although the number of senior housing communities increased substantially, the supply of senior housing options supporting the continuum of care has not necessarily kept up with population growth. Describing the supply of senior housing communities across the spectrum of levels of care provides a more complete description of the formal noninstitutional long-term care supply among the 140 most populated metropolitan statistical areas.

Miller KE, Zhao Jiayi, Laine LT, Coe NB: Growth of Private Pay Senior Housing Communities in Metropolitan Statistical Areas in the United States: 2015-2019. Medical care research review (MCRR) Jul 2022 Notes: Online ahead of print.

Sweetened beverage taxes: Economic benefits and costs according to household income

Taxing sweetened beverages has emerged as an important and effective policy for addressing their overconsumption. However, taxes may place a greater economic burden on people with lower incomes. We assess the degree to which sweetened beverage taxes in three large US cities placed an inequitable burden on populations with lower incomes by assessing spending on beverage taxes by income after taxes have been implemented, as well as any net transfer of funds towards lower income populations once allocation of tax revenue is considered. We find that while lower income populations pay a higher percentage of their income in beverage taxes, there is no difference in absolute spending on beverage taxes per capita, and that there is a sizable net transfer of funds towards programs targeting lower income populations. Thus, when considering both population-level taxes paid and sufficiently targeted allocations of tax revenues, a sweetened beverage tax may have characteristics of an equitable public policy.

Smith JC, Knox MA, Coe NB, Walkinshaw LP, Schoof J, Hamilton D, Hurvitz PM, Krieger J: Sweetened beverage taxes: Economic benefits and costs according to household income. Food Policy 110: 102277, Jul 2022.

The value of an additional day of post-acute care in a skilled nursing facility

With ongoing efforts to improve the value of health care in the U.S. and reduce wasteful spending, we examine empirically the value tradeoffs involved in an additional day in a skilled nursing facility (SNF) after hospital discharge. To control for potential endogeneity, we use the percentage of Medicare beneficiaries enrolled in Medicare Advantage in each county-year as an instrument for individuals’ SNF length of stay among Traditional Medicare beneficiaries, as local Medicare Advantage penetration puts downward pressure on SNF length of stay for all SNF patients but does not directly affect utilization management of those enrolled in Traditional Medicare. We also test for heterogeneity in treatment effect across patients by clinical complexity and two non-health-related factors, marital status and nursing home profit status. We find that one additional day in a SNF lowers short-term readmission rates, but this effect is small and heterogeneous across patient-types. The most clinically complex patients (those with the longest predicted SNF stays) benefit the most from an additional SNF day, as do patients whose stays are shorter due to non-health-related factors. The cost savings from reduced readmission rates are small and do not offset the additional SNF costs.

Werner RM, Coe NB, Qi M, Konetzka T: The value of an additional day of post-acute care in a skilled nursing facility. American Journal of Health Economics 8(4), Jul 2022.

Racial and Ethnic Disparities in Dementia Care Next Steps

No abstract available

Coe NB, Lee C: Racial and Ethnic Disparities in Dementia Care: Next Steps (Invited Commentary, Geriatrics) JAMA Network Open 5(6): e2216267, Jun 2022.

The Impact of Care Intensity and Work on the Mental Health of Family Caregivers: Losses and Gains

We estimate the causal impact of intensive caregiving, defined as providing at least 80 h of care per month, and work on the mental health of caregivers while considering possible sources of endogeneity in these relationships.

Kolodziej I, Coe NB, Van Houtven C: The Impact of Care Intensity and Work on the Mental Health of Family Caregivers: Losses and Gains. The Journal of Gerontology: Social Sciences 77(Suppl_1): S98-S111, May 2022.

Younger Individuals Increase Their Use of Nursing Homes Following ACA Medicaid Expansion

This study examines the effect of Medicaid eligibility expansion under the Affordable Care Act (ACA) on the utilization of nursing home services by younger individuals and those covered by Medicaid.

Ritter A, Freed S, Coe NB: Younger Individuals Increase Their Use of Nursing Homes Following ACA Medicaid Expansion. Journal of the American Medical Directors Association 23(5): 852-857, May 2022.

Out-of-pocket costs attributable to dementia: A longitudinal analysis

Alzheimer's disease and related dementias (ADRD) affect 5.7 million Americans, and are expensive despite the lack of a cure or even treatments effective in managing the disease. The literature thus far has tended to focus on the costs to Medicare, even though one of the main characteristics of ADRD (the loss of independence and ability to care for oneself) incurs costs not covered by Medicare. In this paper, we use survey data for 2002-2016 from the Health and Retirement Study to estimate the out-of-pocket costs of ADRD for the patient and their family through the first 8 years after the onset of symptoms, as defined by a standardized 27-point scale of cognitive ability. A two-part model developed by Basu and Manning (2010) allows us to separate the costs attributable to ADRD into two components, one driven by differences in longevity and one driven by differences in utilization.

Oney M, White L, Coe NB: Out-of-pocket costs attributable to dementia: A longitudinal analysis. Journal of the American Geriatrics Society (JAGS) 70(5): 1538-1545, May 2022.