Medicare Expenditures of Individuals with Alzheimer's Disease and Related Dementias or Mild Cognitive Impairment Before and After Diagnosis
Medicare Expenditures of Individuals with Alzheimer's Disease and Related Dementias or Mild Cognitive Impairment Before and After Diagnosis
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DOI：
10.1111/jgs.14227
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发表时间：
2016-08-01
影响因子：
6.3
通讯作者：
Neumann, Peter J.
中科院分区：
文献类型：
--
作者：
Lin, Pei-Jung;Zhong, Yue;Neumann, Peter J.
目的描述阿尔茨海默病和相关痴呆（ADRD）或轻度认知障碍（MCI）编码诊断患者在诊断前和诊断后期间的医疗保险支出和使用趋势。设计回顾性观察性队列研究。设置2009年至2013年医疗保险索赔文件的5%样本。患者新诊断为ADRD的患者（n = 25，916）或MCI（n = 2，784），每一个都有一个倾向评分匹配的对照组。测量在新诊断为ADRD或MCI之前和之后的24个月内的医疗保险支出和使用情况。MCI患者在诊断前一年的平均住院费用（10，622美元对15，091美元，P <0.001）比对照组高41%（9，728美元对13，691美元，P <0.001）。ADRD参与者的医疗保险支出在诊断后的前12个月立即增加到27，126美元，并在之后的12个月内下降到17，257美元。对于MCI参与者，诊断后12个月的平均医疗保险支出为20，386美元，诊断后12个月为14，286美元。使用住院治疗，急性期后熟练的护理设施的护理，和家庭医疗保健大大增加ADRD或MCI的诊断后，ADRD和MCI的参与者产生显着较高的医疗费用比匹配的对照组，甚至在他们收到正式的诊断。ADRD和MCI患者的医疗保险支出可能在诊断前至少12个月开始增加，在诊断后的前几个月达到峰值，之后下降，但仍保持在高于诊断前的水平。这些发现强调了早期诊断的重要性，并表明需要进行复杂的病例管理，以协调ADRD和MCI患者的护理过渡。
ObjectivesTo characterize Medicare expenditure and usage trends in individuals with a coded diagnosis of Alzheimer's disease and related dementia (ADRD) or mild cognitive impairment (MCI) during the periods leading up to and after diagnosis.DesignRetrospective observational cohort study.SettingFive percent sample of the 2009 to 2013 Medicare claims files.ParticipantsIndividuals newly diagnosed with ADRD (n = 25,916) or MCI (n = 2,784), each with a propensity-score matched control subject.MeasurementsMedicare expenditures and usage during the 24 months before and after a new diagnosis of ADRD or MCI.ResultsMedicare expenditures were 42% higher in participants with ADRD ($10,622 vs $15,091, P < .001) and 41% higher in those with MCI ($9,728 vs $13,691, P < .001) during the year before diagnosis than in matched controls. Medicare expenditures of participants with ADRD increased to $27,126 for the first 12 months immediately after diagnosis and decreased to $17,257 during the 12 months after that. For participants with MCI, average Medicare expenditures were $20,386 for the 12 months after diagnosis and $14,286 for the 12 months after that. Use of inpatient care, postacute skilled nursing facility care, and home health care increased substantially after diagnosis of ADRD or MCI.ConclusionParticipants with ADRD and MCI incurred significantly higher Medicare expenditures than matched controls, even before they received a formal diagnosis. Medicare expenditures of individuals with ADRD and MCI may start to increase at least 12 months before their diagnosis, peak during the first few months immediately after diagnosis, and decrease afterward but remain at a higher level than before diagnosis. These findings highlight the importance of early diagnosis and indicate the need for complex case management to coordinate care transitions for individuals with ADRD and MCI.