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Detection of Cognitive Impairment after Critical Illness with the Medicare Annual Wellness Visit: A Cohort Study.

Authors
  • Palakshappa, Jessica A1
  • Callahan, Kathryn E2
  • Pajewski, Nicholas M3
  • Files, Daniel Clark1
  • Willard, James J3
  • Williamson, Jeff D2
  • 1 Section on Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Department of Internal Medicine.
  • 2 Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, and.
  • 3 Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Type
Published Article
Journal
Annals of the American Thoracic Society
Publisher
American Thoracic Society
Publication Date
Oct 01, 2021
Volume
18
Issue
10
Pages
1702–1707
Identifiers
DOI: 10.1513/AnnalsATS.202011-1434OC
PMID: 33735597
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Rationale: Cognitive impairment after critical illness is common in observational studies of older intensive care unit (ICU) survivors. The rate of screening for and diagnosis of cognitive impairment in ICU survivors in nonresearch settings is unknown. Objectives: To determine how often cognitive impairment was detected in older adults in the year after critical illness at an academic medical center as part of 1) the Medicare Annual Wellness Visit (AWV) and 2) routine clinical care. Methods: This study was a retrospective cohort study conducted at an urban academic medical center. The study included 696 patients aged 65 years and older admitted to the medical ICU between October 1, 2016, and October 1, 2018, and discharged alive. Patients were also required to have a health system-affiliated primary care provider. Patients were followed for 1 year. We defined cognitive impairment detected in the AWV as either an indicated diagnosis of cognitive impairment or dementia or patient, family, or provider indication of memory concerns during the AWV. We modeled the incidence of AWV completion and the detection of cognitive impairment using semiparametric additive models accounting for the competing risk of death. Results: Over 1 year of follow-up, the cumulative incidence of mortality was 23.0% (95% confidence interval [CI], 19.9-26.1%), with 24.7% (95% CI, 21.5-27.9%) completing the AWV. The cumulative incidence of cognitive impairment first detected through the AWV was 3.4% (95% CI, 1.8-5.0%) at 1 year, with a higher cumulative incidence for diagnoses of cognitive impairment or dementia first indicated via encounter diagnosis codes or the electronic health record problem list (5.9%; 95% CI, 3.9-7.9%). Conclusions: The results of our study suggest that the currently implemented AWV is unlikely to be an adequate mechanism for detecting cognitive impairment in a high-risk population such as those recovering from critical illness.

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