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- Title
State Department of Motor Vehicles Reporting Mandates of Dementia Diagnoses and Dementia Underdiagnosis.
- Authors
Jun, Hankyung; Liu, Ying; Chen, Emily; Becker, Andrew; Mattke, Soeren
- Abstract
Key Points: Question: Are state Department of Motor Vehicles mandates for clinicians to report drivers with dementia associated with dementia underdiagnosis? Findings: Analyzing full Medicare claims data on 223 036 primary care clinicians, this cross-sectional study found that clinicians in states that require reporting of a dementia diagnosis had an adjusted 12.4% probability of underdiagnosing dementia. In states with requirements that drivers self-report dementia diagnoses, the probability of underdiagnosing was 7.8%, and in states without mandates, the probability of underdiagnosing was 7.7%. Meaning: This study suggests that mandating clinicians to report a dementia diagnosis may be associated with missed or delayed diagnoses. Importance: With older drivers representing the fastest growing segment of the driver population and dementia prevalence increasing with age, policymakers face the challenge of balancing road safety and mobility of older adults. In states that require reporting a dementia diagnosis to the Department of Motor Vehicles (DMV), individuals with dementia may be reluctant to disclose symptoms of cognitive decline, and clinicians may be reluctant to probe for those symptoms, which may be associated with missed or delayed diagnoses. Objective: To assess whether DMV reporting policies for drivers with dementia are associated with primary care clinicians' underdiagnosing dementia. Design, Setting, and Participants: This cross-sectional study used data from the 100% Medicare fee-for-service program and the Medicare Advantage plans from 2017 to 2019 on 223 036 primary care clinicians with at least 25 Medicare patients. Statistical analysis was performed from July to October 2023. Exposures: State DMV reporting policies for drivers with dementia. Main Outcomes and Measures: The main outcome was a binary variable indicating whether the clinician underdiagnosed dementia or not. Each clinician's expected number of dementia cases was estimated using a predictive model based on patient characteristics. Comparing the estimation with observed dementia diagnoses identified clinicians who underdiagnosed dementia vs those who did not, after accounting for sampling errors. Results: Four states have clinician reporting mandates, 14 have mandates requiring drivers to self-report dementia diagnoses, and 32 states and the District of Columbia do not have explicit requirements. Among primary care clinicians in states with clinician reporting mandates (n = 35 620), 51.4% were female, 91.9% worked in a metropolitan area, and 19.9% of the patient panel were beneficiaries dually eligible for Medicare and Medicaid. Among primary care clinicians in states with patient self-reporting mandates (n = 57 548), 55.7% were female, 83.1% worked in a metropolitan area, and 15.4% of the patient panel were dually eligible for Medicare and Medicaid. Among clinicians in states without mandates, 55.7% were female, 83.0% worked in a metropolitan area, and 14.6% of the patient panel were dually eligible for Medicare and Medicaid. Clinicians in states with clinician reporting mandates had an adjusted 12.4% (95% CI, 10.5%-14.2%) probability of underdiagnosing dementia compared with 7.8% (95% CI, 6.9%-8.7%) in states with self-reporting and 7.7% (95% CI, 6.9%-8.4%) in states with no mandates, an approximately 4–percentage point difference (P <.001). Conclusions and Relevance: Results of this cross-sectional study of primary care clinicians suggest that mandatory DMV policies for clinicians to report patients with dementia may be associated with a higher risk of missed or delayed dementia diagnoses. Future research is needed to better understand the unintended consequences and the risk-benefit tradeoffs of these policies. This cross-sectional study used Medicare claims data to evaluate whether state Department of Motor Vehicles (DMV) mandates for clinicians to report drivers with dementia are associated with dementia underdiagnosis.
- Subjects
DIAGNOSIS of dementia; PUBLIC health laws; SAFETY; CROSS-sectional method; RESEARCH funding; GOVERNMENT agencies; SEX distribution; HEALTH policy; DIAGNOSTIC errors; DESCRIPTIVE statistics; AGE distribution; CHI-squared test; ODDS ratio; COGNITION disorders; DELAYED diagnosis; DATA analysis software; AUTOMOBILE drivers' tests; CONFIDENCE intervals; MOTOR vehicles; OLD age
- Publication
JAMA Network Open, 2024, Vol 7, Issue 1, pe248889
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.8889