Functional impairment, healthcare costs and the prevalence of institutionalisation in patients with Alzheimer's disease and other dementias
Functional impairment, healthcare costs and the prevalence of institutionalisation in patients with Alzheimer's disease and other dementias
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DOI：
10.2165/00019053-200624030-00006
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发表时间：
2006-01-01
影响因子：
4.4
通讯作者：
Chang, SB
中科院分区：
文献类型：
--
作者：
Hill, J;Fillit, H;Chang, SB
引言：阿尔茨海默病和其他痴呆（ADOD）患者的功能状态进行性下降是有据可查的。然而，关于改善ADOD人群功能状态的干预措施的经济效益的信息有限。本研究估计与ADOD和他们的医疗费用和患病率institutionalisation.Methods：回顾性横断面分析的医疗保险当前受益人调查（MCBS）的患者的功能障碍的程度之间的关系。从1995年至1998年的MCBS（n = 3138）的浪潮中确定了一个具有全国代表性的ADOD医疗保险受益人样本：34%在社区，57%的机构和9%的居住在这两个设置在这一年。使用了三种功能测量：日常生活活动（ADL）和独立ADL（IADL）受损的数量;总结ADL和IADL受损数量和严重程度的指数;以及ADL的Katz指数。医疗保健费用包括在所有情况下获得的所有医疗保健服务的费用，无论这些服务是否由保险支付或自付。每个措施的损害和医疗费用和患病率的institutionalisation.Results之间的关系估计使用线性和逻辑回归：医疗费用（1995-8值）为所有ADOD患者增加了US 1958美元（p < 0.001），为每个额外的ADL损害和US 549美元（p=0.073）为每个额外的IADL损害。对于社区居住的ADOD患者，每增加一个ADL，医疗费用增加1541美元（p < 0.001），每增加一个IADL，医疗费用增加714美元（p=0.022）。成本也增加了严重的总结指数和卡茨指数。机构化的几率也增加了三个措施的功能impairment.Conclusion：虽然功能和成本之间的关系已被描述为以前，这些关系的确切性质还没有被调查仅在痴呆症患者。这项研究的数据表明，功能障碍和医疗费用之间存在密切关系，特别是在痴呆症患者中。即使是轻度至中度痴呆症中常见的IADL损伤，也可能显着增加成本。研究结果表明，改善功能的治疗和护理管理可能会降低其他医疗费用。
Introduction: The progressive decline in functional status for patients with Alzheimer's disease and other dementias (ADOD) is well documented. However, there is limited information on the economic benefits of interventions improving functional status in an ADOD population. This study estimated the relationship between the degree of functional impairment in patients with ADOD and their healthcare costs and prevalence of institutionalisation.Methods: Retrospective cross-sectional analyses of the Medicare Current Beneficiary Survey (MCBS) were performed. A nationally representative sample of Medicare beneficiaries with ADOD was identified from the 1995-8 waves of the MCBS (n = 3138): 34% in the community, 57% institutionalised and 9% residing in both settings during the year. Three measures of functioning were used: the number of activities of daily living (ADLs) and independent ADLs (IADLs) impaired; an index summarising number and severity of ADL and IADL impairments; and the Katz Index of ADLs. Healthcare costs included costs for all healthcare services received in all settings, regardless of whether they were covered by insurance or paid out of pocket. The relationships between each measure of impairment and healthcare costs and prevalence of institutionalisation were estimated using linear and logistic regression.Results: Healthcare costs (1995-8 values) for all ADOD patients increased by $US1958 (p < 0.001) for each additional ADL impairment and $US549 (p=0.073) for each additional IADL impairment. For community-dwelling ADOD patients, healthcare costs increased by $US1541 (p < 0.001) for each additional ADL and $US714 (p=0.022) for each additional IADL. Costs also increased by severity on the summary index and the Katz Index. Odds of institutionalisation also increased by the three measures of functional impairment.Conclusion: Although relationships between function and costs have been described previously, the exact nature of these relationships has not been investigated solely in patients with dementia. The data from this study suggest a strong relationship between functional impairment and healthcare costs, specifically in patients with dementia. Even IADL impairments, which are common in mild to moderate dementia, may significantly raise costs. The results suggest that therapies and care management that improve functioning may possibly reduce other healthcare costs.