Project 2 - Provider-Patient/Caregiver Demographic Concordance in Health Care Systems: Their Influence on Health and Healthcare Outcomes for Populations with ADRD

Summary/Abstract Patients may be seen by providers with similar or very different demographic characteristics. The proposed project will harness several decades of Medicare data from rural and urban regions to test whether trust differs between discordant and concordant pairings for patients with Alzheimer’s disease and related dementias (ADRD) as well as others. Using novel data sources on physician demographics, together with quasi-experimental variation in the “match” that occurs in Emergency Department (ED) settings as well as an instrumental variables strategy, we will test whether concordance has any causal relationship with healthcare and health, including ED visits for ambulatory care sensitive conditions, in-patient admissions, readmissions, healthy days in the community, medication adherence, and mortality. We will test whether a relationship exists between concordance and health, and if it exists, whether it is mediated by various factors, and how potential effects may change over time. ADRD patients comprise a large fraction of Medicare beneficiaries who present in EDs and are highly reliant on primary care physicians because of shortages of specialists. Finally, we will test whether or not there is any impact of demographic (non-)concordance in ambulatory care settings, where greater sorting may occur, to emergency department settings, where there is quasi-random assignment of patients to providers. Project 2 anchors the Program Project’s focus on healthcare variation across the population, complementing the work of other projects that also look at the cross-population variations in care for ADRD patients and others in a variety of healthcare contexts.