The impact of hospital-based health information technology on health care quality and equity among patients with ADRD

Alzheimer's disease and related dementia (ADRD) is considered one of the most expensive health conditions.
Patients with ADRD have more emergency department visits, hospitalizations, ambulatory care sensitivity
hospitalization, readmissions, skilled nursing home stays, and home health visits compared to adults without
an ADRD diagnosis. Racial and ethnic minorities with ADRD are at high risk for uncoordinated and low-quality
care, including higher rates of hospitalizations, preventable hospitalization, avoidable emergency department
visits, and health care expenditures. Hospital-based health information technology (hereinafter “hospital-HIT”)
is increasingly being used to support care coordination, advance patient engagement, and improve health
information exchange. Our team has developed a conceptual framework that delineates the critical roles of
hospital-HIT and its application in the care of ADRD patients. Our preliminary findings further show evidence
that HIT-supported care can work effectively in ADRD populations. It is critical to implement more robust
analyses and comprehensive assessments of the impact of hospital-HIT on health care quality and equity to
inform policymakers in the design and implementation of HIT, across the changing needs of ADRD patients
(and their caregivers) as dementia progresses. In addition, the COVID-19 pandemic has disproportionately
impacted patients with ADRD, especially racial and ethnic minorities. However, the impact of hospital-HIT on
health outcomes and equity for persons with ADRD during the pandemic is still lacking. Hence, through the use
of ten-year longitudinal dataset before, during, and post the COVID-19 pandemic, and by applying cutting-edge
econometric models, this study aims to systematically assess the impact of hospital-HIT on health care quality
and equity of patients with ADRD, including the health outcomes during the pandemic. We hypothesize that
hospital-HIT that aims to promote care coordination, patient engagement, and data integration can improve
health care quality and reduce health care expenditure; and that these impacts will be more pronounced for
racial and ethnic minority patients who face substantial barriers to accessing high-quality care. Specifically, we
propose to evaluate the impact of hospital-HIT on health care quality (i.e., reduce readmission, preventable ED
visits, and preventable hospitalizations) (Aim 1), estimate the extent to which hospital-HIT has reduced racial
and ethnic disparities of health care quality and expenditures for the aging population with ADRD (Aim 2); and
estimate the extent to which hospital-HIT has impacted health outcomes and quality during the pandemic (Aim
3). Grounded in the HIT-Structural Racism and Discrimination framework for ADRD patients, we expect our
results to quantify the impact of hospital-HIT on health care quality for patients with ADRD, including those
from racial and ethnic minority groups and communities with different social determinants of health. Results on
the impact of hospital-HIT during the pandemic will improve the understanding of how to use hospital-HIT to
coordinate care for people with ADRD during the pandemic.

Grant Number: 1RF1AG083175-01
NIH Institute/Center: NIH
Principal Investigator: Jie Chen