# A National Analysis of Observation Care Among Medicare Beneficiaries with Alzheimer's Disease and Related Dementias

> **NIH NIH R56** · BETH ISRAEL DEACONESS MEDICAL CENTER · 2022 · $779,135

## Abstract

Emergency department (ED) visits are common in the United States, with approximately 1 in 5
Americans visiting the ED at least once per year. Older adults, particularly those with
Alzheimer’s Disease and Related Dementias (ADRD), use the ED at higher rates and have an
even greater risk of adverse outcomes. Crowded ED conditions may pose particular safety risks
for those with impaired cognition. Observation unit care has been proposed as a solution to the
time-pressured nature of emergency care. Indeed, there has been a marked growth in recent
years in the use of observation care for older adults presenting to the ED. Yet, there is concern
that observation stays may be inappropriate for some patients and may be associated with
poorer outcomes compared to a traditional inpatient stay. Evidence suggests that observation
care yields the best outcomes when limited to protocolized care for specific conditions. Yet, the
majority of observation care is not provided in such structured settings. Thus, the ideal model of
observation care is likely not the predominant one, particularly for the population of patients with
Alzheimer’s disease and related dementias (ADRD), who more often present to the ED with
nonspecific symptoms and conditions that are less well-defined. Yet, evidence on the modern
landscape of observation care for adults with ADRD is lacking. We will use national Medicare
claims to examine trends in the utilization and intensity of observation care for Medicare
beneficiaries with ADRD. We will use a novel approach to evaluate the degree to which certain
hospitals have been substituting observation stays for inpatient care, direct ED discharge or
both. Furthermore, we will characterize the trends in clinical outcomes associated with
observation care for beneficiaries with ADRD. We will use Medicare claims to identify the
patient, hospital and regional-level variables that are associated with these outcomes. We will
use the findings from analyses of national Medicare claims to develop a risk-prediction tool for
frontline clinicians to risk-stratify beneficiaries with ADRD for adverse outcomes associated with
observation care. This national, longitudinal study will enable frontline clinicians to better tailor
the use of observation care to the needs of patients with ADRD.

## Key facts

- **NIH application ID:** 10670478
- **Project number:** 1R56AG075017-01A1
- **Recipient organization:** BETH ISRAEL DEACONESS MEDICAL CENTER
- **Principal Investigator:** Laura G Burke
- **Activity code:** R56 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $779,135
- **Award type:** 1
- **Project period:** 2022-09-30 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10670478

## Citation

> US National Institutes of Health, RePORTER application 10670478, A National Analysis of Observation Care Among Medicare Beneficiaries with Alzheimer's Disease and Related Dementias (1R56AG075017-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10670478. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*