Our Research

In 2022, an estimated 6.5 million Americans aged 65 and older were living with of Alzheimer’s disease and related dementias (ADRD), and this number is projected to increase to 14 million by 2060.

ADRD is a rapidly growing public health concern that disproportionately affects Black and Hispanic older adults, as they are about twice and 1.5 times as likely, respectively, to be diagnosed with ADRD than older non-Hispanic White Americans. The CDC estimates that by 2060, ADRD cases among Black and Hispanic Americans will increase seven and four times, respectively, over today’s estimates. Socioeconomically disadvantaged Black and Hispanic older adults are not only at substantially greater risk of incident ADRD but are also at risk of higher adverse health events such as emergency visits, potentially preventable hospitalizations, and 30-day hospital readmission than their White counterparts. Reducing disparities in access to services that may help older adults with ADRD to stay in the community safely is a salient health policy priority.

Research Areas

Examining frequent Hospitalizations and Readmission among people with dementia

My research colleagues and I have found that patients with dementia are at higher risk of frequent hospitalizations and 30-day readmissions. In the U.S., hospitalizations account for the greatest proportion of direct medical costs. For example, potentially preventable hospitalizations cost $10 billion annually in the U.S., and with a 6% inpatient mortality rate, only one-third of older adults with dementia admitted to the hospital from their homes are discharged back into the community after a hospitalization. Moreover, frequent and avoidable hospital admissions increase the risk of patients experiencing harmful health situations.

Hospitalized patients with dementia are more likely to experience hospital-associated complications such as delirium and falls, which put them at a higher risk of long-term institutionalization and mortality.

Mahmoudi E, Kamdar N, Furgal A, Sen A, Zazove P, Bynum J: Potentially preventable hospitalizations among older adults: 2010-2014, Annals of Family Medicine.18(6): 511-519, 01/2020. PM33168679

Mahmoudi E, Lin P, Khan A, Kamdar N, Peterson MD: Potentially Preventable Hospitalizations Among Adults with Pediatric-Onset Disabilities. Mayo Clinic proceedings, S0025-6196(22)00468-2, 11/2022. PM36336517

Ratakonda S, Lin P, Kamdar N, Meade M, McKee M, Mahmoudi E. Potentially Preventable Hospitalization Among Adults with Hearing, Vision, and Dual Sensory Loss: A Case and Control Study. Mayo Clin Proc Innov Qual Outcomes. 2023;21;7(4):327-336. PMC10391598.

Mahmoudi E, Lin P, Rubenstein D, Guetterman T, Leggett A, Possin KL, Kamdar N. Use of preventive service and potentially preventable hospitalization among American adults with disability: Longitudinal analysis of Traditional Medicare and commercial insurance. Preventive medicine reports, 40:102663, 02/2024. PMC10920729

Assessing Potentially Preventable Hospitalizations (PPH)

The Agency for Healthcare Research and Quality (AHRQ) has developed measures of conditions that require outpatient care or potentially preventable hospitalization (PPH) to enable assessment of the quality-of-care measures. PPHs are expensive and are considered care that adds no patient value. Evidence suggests that incidences of PPHs are higher among people with fewer resources and with lower access to care and those with complex care needs.

My research colleagues and I have published work on PPH, indicating that accessible care, care continuity, and preventive care are strongly associated with reducing the risk of PPH.

Mahmoudi E, Kamdar N, Kim N, Gonzales G, Singh K, Waljee AK: Use of electronic medical records in development and validation of risk prediction models of hospital readmission: systematic review, The BMJ.36904/2020. PM32269037

Kamdar N, Syrjamaki J, Aikens JE, Mahmoudi E: Readmission Rates and Episode Costs for Alzheimer Disease and Related Dementias Across Hospitals in a Statewide Collaborative, JAMA Network Open.6(3):e232109, 03/2023. PM10020873

Wu W, Holkeboer K, Kolawole T, Carbone L, Mahmoudi E: Natural Language Processing to Identify Social Determinants of Health in Alzheimer’s Disease and Related Dementia from Electronic Health Records. Health Services Research. 58(6):1292-1302, 12/2023

Mahmoudi E, Margosian S, Lin P: Racial/Ethnic Disparities in Hospital Readmission and Frequent Hospitalizations Among Medicare Beneficiaries with Alzheimer’s Disease and Related Dementia: Traditional Medicare vs. Medicare Advantage. The journals of gerontology. Series B, Psychological sciences and social sciences, 1;79(7):gbae078, 07/2024. PMC11212310

Evaluating the Effects of Health Policies on Disparities in Access to Healthcare

Reducing racial and ethnic disparities in access to medical care have been important national policy goals, ones that I believe my research contributes towards achieving. However, considerable disparities in various areas of healthcare still exist. To eliminate these disparities, it is essential to evaluate healthcare policies and their helpful, or harmful, effects on reducing existing inequalities.

Mahmoudi E, Jensen GA: Has Medicare part D reduced racial/ethnic disparities in prescription drug use and spending? Health Services Research.49(2): 502-525, 01/2014. PM24102408

Mahmoudi E and Levy H. How Did Medicare part D affect racial and ethnic disparities in drug coverage? J Gerontol B Psychol Sci Soc Sci, 2014;71(3):581-9. PMC6372055

Mahmoudi E, Tarraf W, Maroukis BL, Levy HG: Does Medicare Managed care reduce racial/ethnic disparities in diabetes preventive care and healthcare expenditures? American Journal of Managed Care.22(10): e360-e367, 10/2016. PM28557519

Mahmoudi E. Lu Y, Metz A, Momoh A, Chung KC. Association of a policy mandating physician-patient communication with racial/ethnic disparities in post-mastectomy breast reconstruction. JAMA Surg, 2017;152(8);775-83. PMC5710498

Examining disparities in access to and use of healthcare

While health disparities are a result of factors deeply rooted in culture, lifestyle, socioeconomic status, and accessibility of resources, healthcare disparities are a result of these factors, which reflect differences in access to and quality of healthcare. They can also result due to the healthcare system’s inability to address specific populations’ needs.

Our findings indicate that individual socioeconomic and neighborhood characteristics are strongly associated with delayed access and unmet medical needs. As an example, living at or near the poverty level, having less education, and fewer resources significantly increase the odds of unmet or delayed access to care. Our studies have important policy implications and community program development potential, which can reduce healthcare disparities and improve vulnerable populations’ health and quality of life.

Mahmoudi E, Jensen GA: Diverging racial and ethnic disparities in access to physician care: Comparing 2000 and 2007, Medical Care.50(4): 327-334, 04/2012. PM22388557

Mahmoudi E, Meade MA: Disparities in access to health care among adults with physical disabilities: Analysis of a representative national sample for a ten-year period, Disability and Health Journal.8, (2): 182-190, 04/2015.

Cohen AJ, Lachance LL, Richardson CR, Mahmoudi E, Buxbaum JD, Noonan GK, Murphy EC, Roberson DN, Hesterman OB, Heisler M, Zick SM: “Doubling Up” on Produce at Detroit Farmers Markets: Patterns and Correlates of Use of a Healthy Food Incentive, American Journal of Preventive Medicine.54(2): 181-189, 02/2018. PM29246675

Mahmoudi E, Cohen A, Buxbaum J, Richardson CR, Tarraf W: Gaining Medicaid coverage during ACA implementation: Effects on access to care and preventive services, Journal of Health Care for the Poor and Underserved.29(4): 1472-1487, 11/2018. PM30449758

Research Summaries

Enrollment in Medicare Advantage is linked with lower risks of hospitalizations and readmissions for patients with Alzheimer’s Disease and related Dementia

As healthcare costs continue to rise for millions of older Americans living with Alzheimer’s Disease and related Dementia (ADRD), researchers at the University of Michigan have found that individuals enrolled in Medicare Advantage (MA) have a lower risk of hospitalization, as well as all-cause 30-day hospital readmission, in contrast to those who are enrolled in traditional Medicare (TM).

The researchers cite Alzheimer’s Association statistics that as of 2020, more than 6 million Americans aged 65 and older were living with ADRD. The total costs for caring for these patients is much higher than for those without the conditions — almost $42,000 per person compared with about $14,000 for people without ADRD. The association estimates that approximately 13 million people will be diagnosed with the disease by 2050.

Read the full story written by Elizabeth Katz here.

Can AI help hospitals spot patients in need of extra non-medical assistance?

In the rush to harness artificial intelligence and machine learning tools to make care more efficient at hospitals nationwide, a new study points to another possible use: identifying patients with non-medical needs that could affect their health and ability to receive care.(link is external)

These social determinants of health – everything from transportation and housing to food supply and availability of family and friends as supports – can play a major role in a patient’s health and use of health care services.

The new study focuses on a patient population with especially complex needs: people with Alzheimer’s disease or other forms of dementia. Their condition can make them especially reliant on others to get them to medical appointments and social activities, handle medications and finances, and shop and prepare food.

Read the full story written by Kara Gavin of Michigan Medicine Department of Communication here.

New research finds that Black and Hispanic people with disabilities receive less preventive care, even when they are privately insured

Patients from historically disenfranchised racial and ethnic groups who also have disabilities face significant burdens accessing primary care services. As a result, they are at higher risk for multimorbidity and adverse health events.

While health insurance-covered preventive services provided through primary care improves health outcomes in the general population, it’s unclear if these same outcomes extend to privately insured people with disabilities who are also from marginalized populations.

A new study supported by researchers from the Department of Family Medicine found that even when Black and Hispanic patients with disabilities were privately insured, their utilization of preventive care services was significantly lower than people with no disabilities. Their study, “Racial and ethnic inequities in use of preventive services among privately insured adults with pediatric-onset disability,” was recently published in the Annals of Family Medicine(link is external).