Document Detail

Underuse of diagnostic codes for specific dementias in the veterans affairs new England healthcare system.
MedLine Citation:
PMID:  22587853     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVES: To examine the specificity of dementia coding in large populations.
DESIGN: Retrospective cohort and chart review study of dementia diagnosis.
SETTING: U.S. Department of Veterans Affairs (VA) New England healthcare system.
PARTICIPANTS: Veterans aged 50 and older given outpatient visit codes for dementia between January 1, 2000, and December 31, 2009.
MEASUREMENTS: The frequency of the code "dementia not otherwise specified (DNOS)" as a first and final diagnosis was determined. DNOS use was examined according to provider type and geographic location. The medical records of 100 individuals with unspecified dementia were reviewed to determine their underlying diagnoses and describe their examination.
RESULTS: Twenty-two thousand fifty veterans diagnosed with dementia were identified over 10 years of follow-up. One-third of all cases had no specific dementia code (n = 6,659). DNOS was the most commonly used code as a first dementia diagnosis (42.5%) and was second only to Alzheimer's type dementia (35.8%) as a final diagnosis. Individuals who saw geriatricians and neurologists were most likely to have a specific dementia diagnosis, and DNOS use was lowest in centers with the most dementia specialists. Only 12% of primary care physicians performed cognitive testing the first time they used the DNOS code, compared with 98% of specialists. Nearly half of individuals with a persistent diagnosis of DNOS met criteria for a specific dementia.
CONCLUSION: Substantial overuse was found of nonspecific dementia codes in the VA New England healthcare system, leading to an underestimation of the prevalence of Alzheimer's disease and other dementias. System-based changes in dementia coding and greater access to dementia specialists may help improve diagnostic specificity.
Daniel Butler; Neil W Kowall; Elizabeth Lawler; J Michael Gaziano; Jane A Driver
Related Documents :
4055333 - Diagnostic accuracy of thyroid aspirative cytology in view of cumulative experience.
1998873 - Primary papillary carcinoma of a thyroglossal duct cyst: report of a case and literatur...
12131953 - Spinal cord tumor in a patient with multiple sclerosis: case report.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American Geriatrics Society     Volume:  60     ISSN:  1532-5415     ISO Abbreviation:  J Am Geriatr Soc     Publication Date:  2012 May 
Date Detail:
Created Date:  2012-05-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7503062     Medline TA:  J Am Geriatr Soc     Country:  United States    
Other Details:
Languages:  eng     Pagination:  910-5     Citation Subset:  IM    
Copyright Information:
© 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
College of Medicine, University of Arizona, Tucson, Arizona.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Are geriatricians more efficient than other physicians at managing inpatient care for elderly patien...
Next Document:  Racial differences in gait velocity in an urban elderly cohort.