National Trends in Emergency Department Provider Types and Their Impact on Dementia Patient Care Outcomes

Document Type

Conference Proceeding

Publication Date

5-13-2025

Publication Title

Acad Emerg Med

Keywords

adult, aged, Alzheimer disease, conference abstract, consultation, controlled study, cross-sectional study, dementia, drug therapy, emergency ward, hospitalization, human, major clinical study, patient care, prevalence, probability, special situation for pharmacovigilance, treatment outcome, United States

Abstract

Background and Objectives: As the U.S. population ages and Alzheimer's Disease and Related Dementias (ADRD) prevalence rises, the ED workforce must adapt to manage these diverse and complex patients. Our study aims to analyze the roles of different provider types and care complexities in managing ADRD in the ED and their impact on patient outcomes. Methods: We conducted a cross-sectional analysis using the National Hospital Ambulatory Medical Care Survey data from 2014 to 2022. We compared outcomes, including hospitalization, between those aged 45 or above with and without ADRD. The sample involved a multi-stage probability design, and each visit was weighted to represent annual ED utilization nationally. We used these weights to estimate proportions for our inclusion criteria and analyzed associations between patient demographics, hospital and provider types, visit details, and care provided. Multivariable logistic regression was employed to estimate associations between provider types, ADRD and other covariates, interaction terms of ADRD and provider type, and patient outcomes, reporting odds ratios with 95% confidence intervals. Results: From 2014 to 2022, there were 38,894,087 ED encounters for patients aged 45 and above, including 1,269,994 ADRD encounters (3.27%). Of these, attending physicians saw 888,533 ADRD encounters (71.0%), resident physicians saw 156,933 (12.55%), and APPs/NPs saw 205,217 (16.41%). The volume of ADRD patients remained constant throughout the study period. No significant variations were observed in provider type by rurality or across the four geographical regions. Admission rates for ADRD patients did not differ significantly from non-ADRD patients (OR 0.86, 95% CI 0.55-1.35); however, ADRD patients required more consultations (OR 10.87, 95% CI 8.49-13.92), and advanced diagnostics, such as MRIs (OR 3.39, 95% CI 1.78-6.45). A multivariable logistic regression model included interaction terms between ADRD status and provider type to evaluate their combined effect on hospitalization disposition, and it showed no significant associations between provider type, ADRD, and hospitalization disposition. Conclusion: This study highlights that attending physicians predominantly manage ADRD patients in the ED, with all provider types playing important roles. These findings inform the need for targeted training and resources to enhance care for this patient population.

Volume

32

Issue

S1

First Page

205

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