# Skilled Nursing Facility Participation in Health Information Exchange and Quality of Care for Patients with Alzheimer's Disease and Related Dementias

> **NIH NIH R56** · WEILL MEDICAL COLL OF CORNELL UNIV · 2021 · $517,254

## Abstract

PROJECT SUMMARY/ABSTRACT
Each year there are 2.4 million skilled nursing facility (SNF) stays for post-acute care among Medicare fee-for-
service beneficiaries. Among these patients, over 60% have Alzheimer’s disease or related dementias
(ADRD). Following hospitalization, ADRD patients are four times more likely to be discharged to a SNF
compared to discharged patients without ADRD. SNF patients with ADRD have worse outcomes than other
SNF patients, including higher re-hospitalization rates, longer SNF stays, and a lower likelihood of being
discharged back to the community. Insufficient information-sharing capabilities between the SNF, the hospital,
and other providers are thought to contribute to the frequency of these events. SNFs were not eligible to
receive incentive payments through the Medicare and Medicaid EHR Incentive Programs that led to
widespread adoption of health information technology among hospitals and physicians. HIE participation is
now being actively promoted by policymakers as means to improve the quality of care in SNFs. However, to
date, there is little evidence of its ability to do so for SNF patients overall and no evidence for SNF patients with
ADRD. This is likely due to a lack of available data on SNF participation in HIE that includes key information,
such as dates of HIE participation. In this project, a novel data source will be used that includes dates of HIE
participation for all SNFs participating in HIE in New York State over an eight-year period (2012-2019). These
data will be merged with a 100% sample of Medicare fee-for-service claims for all beneficiaries with ADRD in
the state who received care in SNFs during the study period to examine the relationship between SNF
participation in HIE and the quality and the cost of care for this population. The relationship between SNF
participation in HIE and the quality of care will also be examined specifically for dual-eligibles and racial
minorities with ADRD, who are more likely to receive fragmented care of lower quality compared to other
Medicare beneficiaries. Our research design includes both a difference-in-differences approach based on the
timing of SNF participation in HIE and an instrumental variable analysis based on a patient’s residence and the
differential distance between the nearest SNF with HIE and the nearest SNF without HIE. The robust study
design will allow estimation strongly indicative of causation. The results of the proposed project will be
important regardless of our findings. It will be the first investigation of whether HIE participation among SNFs
(1) improves the quality of care, (2) lowers health care costs, or (3) reduces income and racial disparities in the
quality of care for ADRD patients. The information will be useful to policymakers, SNF and hospital executives,
physicians, patients, and leaders of health information exchanges.

## Key facts

- **NIH application ID:** 10467821
- **Project number:** 1R56AG072605-01
- **Recipient organization:** WEILL MEDICAL COLL OF CORNELL UNIV
- **Principal Investigator:** Mark Aaron Unruh
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $517,254
- **Award type:** 1
- **Project period:** 2021-09-30 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10467821

## Citation

> US National Institutes of Health, RePORTER application 10467821, Skilled Nursing Facility Participation in Health Information Exchange and Quality of Care for Patients with Alzheimer's Disease and Related Dementias (1R56AG072605-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10467821. Licensed CC0.

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