Variation in follow-up care after a new diagnosis of memory loss or cognitive impairment in a major health system.

Abstract

Objective: Patterns of follow-up care after a new diagnosis of memory loss or cognitive impairment among primary care patients are not well-characterized. We described factors associated with diagnosis and follow-up type.

Methods: This is an observational study using electronic health record data, including patients aged ≥40 years newly diagnosed with memory loss or cognitive impairment via primary care of a major health system in Northeast Ohio and Florida. We assessed differences in the odds of diagnosis of memory loss versus cognitive impairment. We then characterized follow-up care as: 1) medication, 2) labs, or 3) imaging, and 4) any follow-up type. We used mixed effects logistic regression to estimate the odds of follow-up care in four models, adjusting to patient factors, region, and diagnosis type.

Results: Of 21,854 patients, 84% were diagnosed with memory loss and 16% were diagnosed with cognitive impairment. Black patients (versus White) had higher odds of being diagnosed with cognitive impairment versus memory loss. Overall, 49.2% received any follow-up care; 39.7% received labs, 16.7% received imaging, and 5.4% medication. Versus those diagnosed with memory loss, patients diagnosed with cognitive impairment had lower odds of any follow-up (aOR:0.74; 95%CI:0.67-0.81), lower odds of lab orders (aOR:0.70; 95%CI:0.60-0.83), but higher odds of medication (aOR:1.65; 95%CI:1.34-2.04). Compared to patients seen in Ohio, those in Florida had lower odds of any follow-up (aOR:0.56; 95%CI:0.47-0.67).

Conclusions: Diagnosis type varied by some non-clinical factors and this was associated with follow-up care. Standardization of initial diagnostic and follow-up approach is warranted.