Health care utilization and costs in the years preceding dementia identification.
Health care utilization and costs in the years preceding dementia identification.
复制标题
痴呆症确诊前几年的医疗保健利用和费用。
DOI：
10.1002/alz.13476
复制
发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Kelley,AmyS
中科院分区：
文献类型：
--
作者：
Kumar,RajG;Lund,EvanBollens;Ornstein,KatherineA;Li,Jing;Covinsky,KennethE;Kelley,AmyS
有证据表明，痴呆发生后，特别是痴呆诊断后和临终前，医疗保健利用增加；然而，在痴呆症确诊前的几年里，人们对这种药物的使用情况知之甚少。方法在这项回顾性队列研究中，我们从健康与退休研究(HRS) -医疗保险相关样本中获得了5547名受益人的数据（n= 1241名患有痴呆症，n= 4306名未患有痴呆症），以比较痴呆确诊前6年的医疗保健成本和利用的纵向趋势，相对于无痴呆的混杂因素平衡参照组。结果：我们发现，痴呆患者在痴呆确诊前几年的门诊急诊科（ED）、住院、熟练护理、家庭健康使用和总医疗保健费用的患病率高于无痴呆患者在晚年的可比时间内。结论本研究提示痴呆患者在临床表现和诊断前可能存在较大的医疗负担。几项研究已经记录了痴呆症患者生活的巨大医疗相关成本，特别是在生命末期。痴呆症是一种进行性神经退行性疾病，对一些人来说，包括延长的临床前阶段。然而，迄今为止的卫生服务研究很少考虑痴呆症发生前的时间。本研究证明，与人口统计学上相似的无痴呆对照组相比，在痴呆发生前几年，医疗保健的利用率和成本显著升高。
INTRODUCTIONThere is evidence that health care utilization increases after incident dementia, particularly after dementia diagnosis and toward the end of life; however, less is known about utilization in the years before dementia identification.METHODSIn this retrospective cohort study we obtained data onn= 5547 beneficiaries from the Health and Retirement Study (HRS)‐Medicare linked sample (n= 1241 with andn= 4306 without dementia) to compare longitudinal trends in health care costs and utilization in the 6 years preceding dementia identification relative to a confounder‐balanced reference group without dementia.RESULTSWe found that persons with dementia had a greater prevalence of outpatient emergency department (ED), inpatient hospital, skilled nursing, and home health use, and total health care costs in the years preceding dementia identification compared to their similar counterparts without dementia across a comparable timespan in later life.CONCLUSIONSThis study provides evidence to suggest greater healthcare burden may exist well before clinical manifestation and identification of dementia.HighlightsSeveral studies have documented the tremendous healthcare‐related costs of living with dementia, particularly toward the end of life.Dementia is a progressive neurodegenerative disease, which, for some, includes a prolonged pre‐clinical phase. However, health services research to date has seldom considered the time before incident dementia.This study documents that health care utilization and costs are significantly elevated in the years before incident dementia relative to a demographically‐similar comparison group without dementia.