{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T03:15:44Z","timestamp":1790824544100,"version":"4.1.0"},"reference-count":46,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T00:00:00Z","timestamp":1706140800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG075210 for HX MED"],"award-info":[{"award-number":["R01AG075210 for HX MED"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006545","name":"National Institute on Minority Health and Health Disparities","doi-asserted-by":"publisher","award":["U54MD012530 for HX"],"award-info":[{"award-number":["U54MD012530 for HX"]}],"id":[{"id":"10.13039\/100006545","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["alz-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Alzheimer's &amp;amp; Dementia"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>We examined the sequences of clinical care leading to diagnoses of Alzheimer's disease and related dementias (ADRD) using electronic health records from a large academic medical center.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>We included patients aged 65+ with their first ADRD diagnoses from January 1, 2014 to December 31, 2019. Using state sequence analysis, care sequences were defined by the ordering of healthcare utilizations occurred in the 2 years before ADRD diagnosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Of 3621 patients (median age 80), nearly half followed a care sequence of having one primary care visit close to their ADRD diagnosis. Additional care sequences included periodic (<jats:italic>n<\/jats:italic>\u00a0=\u00a0322, 8.9%) and multiple (<jats:italic>n<\/jats:italic>\u00a0=\u00a0416, 11.5%) outpatient visits to primary care and having one (<jats:italic>n<\/jats:italic>\u00a0=\u00a0395, 10.9%), multiple (<jats:italic>n<\/jats:italic>\u00a0=\u00a0469, 13.0%), or highly frequent (<jats:italic>n<\/jats:italic>\u00a0=\u00a0357, 10.7%) outpatient visits to other specialties. Patients\u2019 sociodemographic traits contributed to the variability in care sequences.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Several distinct patterns of care leading to ADRD diagnoses were identified. Integrated care models are needed to promote early identification of ADRD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Highlights<\/jats:title><jats:p><jats:list list-type=\"bullet\">\n<jats:list-item><jats:p>Dementia patients followed distinct care pathways prior to their dementia diagnoses.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Key sociodemographic traits contributed to the variation in the sequences of care.<\/jats:p><\/jats:list-item>\n<jats:list-item><jats:p>Racial differences in the sequencing of care were also found, but only in women.<\/jats:p><\/jats:list-item>\n<\/jats:list><\/jats:p><\/jats:sec>","DOI":"10.1002\/alz.13669","type":"journal-article","created":{"date-parts":[[2024,1,25]],"date-time":"2024-01-25T07:00:40Z","timestamp":1706166040000},"page":"2155-2164","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Care sequences leading to the diagnosis of Alzheimer's disease and related 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