# The Influence of Primary Care Structural Capabilities on Hospitalizations among Older Adults with Dementia

> **NIH NIH R36** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2021 · $48,191

## Abstract

Currently, 5.8 million Americans have Alzheimer's disease and Alzheimer's disease-related dementias
(AD/ADRD). As the segment of the United States population age 65 and older continues to grow, the number
of Americans with AD/ADRD and the use of health care services such as hospitalizations will also increase.
Hospitalizations are more prevalent among older adults with AD/ADRD compared to older adults without
AD/ADRD. Some of these hospitalizations are considered potentially avoidable if individuals have better
access to and quality of primary care. However, delivering high quality primary care is becoming increasingly
challenging given the projected shortage of primary care physicians. On the other hand, the number of nurse
practitioners (NPs) has grown in the recent years and will increase by 93% by 2025. Further, NPs deliver high-
quality and cost-effective care to older adults. Yet, little is known about how to support NPs' ability to deliver
high quality care. Particularly, little is known about how to strengthen structural capabilities, essential practice
features needed for delivering high quality of care, in practices where NPs provide care to older adults with
AD/ADRD. Enhancing primary care delivery through strengthening structural capabilities such as care
coordination, the Electronic Health Record (EHR), and community integration in primary care can be an
effective potential way to reduce hospitalizations among older adults with AD/ADRD. The overall objective of
the proposed study is to assess the effects of primary care structural capabilities in practices employing NPs
on both all-cause and potentially avoidable hospitalizations among Medicare beneficiaries with AD/ADRD. This
dissertation study will use unique cross-sectional data produced in 2018-2019 from a large National Institutes
of Health-funded study and its associated Alzheimer's supplement (PI: Poghosyan, R01 MD011514-03S1).
The following specific aims are proposed: Aim 1. Describe structural capabilities (i.e., availability of care
coordination, EHR, and community integration) in primary care practices where NPs provide care to Medicare
beneficiaries with AD/ADRD. Aim 2. Assess the impact of structural capabilities in primary care practices
employing NPs on potentially avoidable and all-cause hospitalizations among Medicare beneficiaries with
AD/ADRD. We hypothesize that more structural capabilities will be associated with lower hospitalizations
among Medicare beneficiaries with AD/ADRD compared to practices with fewer structural capabilities. Multi-
level linear regression models will be used to assess the impact of structural capabilities on hospitalizations
among older adults with AD/ADRD. Findings from this study will generate evidence about how structural
capabilities may improve primary care delivery for older adults with AD/ADRD. The proposed study is well-
aligned with the mission of the National Institute of Aging to identify ways to reduce illness burdens such as...

## Key facts

- **NIH application ID:** 10190498
- **Project number:** 1R36AG071946-01
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** Vaneh Elena Hovsepian
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $48,191
- **Award type:** 1
- **Project period:** 2021-06-15 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10190498

## Citation

> US National Institutes of Health, RePORTER application 10190498, The Influence of Primary Care Structural Capabilities on Hospitalizations among Older Adults with Dementia (1R36AG071946-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10190498. Licensed CC0.

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