Cost-Effective Care Coordination for People With Dementia at Home.
Cost-Effective Care Coordination for People With Dementia at Home.
复制标题
为痴呆症患者提供具有成本效益的居家护理协调。
DOI：
10.1093/geroni/igz051
复制
发表时间：
2020
影响因子：
7
通讯作者：
Samus,QuincyM
中科院分区：
文献类型：
--
作者：
Willink,Amber;Davis,Karen;Johnston,DeirdreM;Black,Betty;Reuland,Melissa;Stockwell,Ian;Amjad,Halima;Lyketsos,ConstantineG;Samus,QuincyM
摘要背景和目的痴呆症患者（PWD）是生活在社区中最需要和最昂贵的人群。在家最大化独立性（MIND）是一个潜在的具有成本效益和可扩展的基于家庭的痴呆症护理协调计划，该计划使用训练有素的非临床社区工作者作为PWD及其护理伙伴之间的主要联系人，并由具有痴呆症护理专业知识的多学科临床团队提供支持。研究设计和方法根据护理管理人员在家庭干预的前12个月所花费的实际时间计算护理管理服务的成本，来自巴尔的摩、马里兰州和周边地区的342名家庭接受者参加了医疗保险和医疗补助服务中心（CMS）资助的医疗保健创新奖示范项目。对120名具有双重资格的家庭MIND参与者的基于索赔的医疗补助支出进行差异分析，其倾向评分与对照组匹配（n= 360）。结果：平均每人每月的费用为110美元，每年为1,320美元。双重资格参与者的医疗补助支出每季度增长1.12个百分点，比匹配的对照组慢。大部分节省来自住院和长期疗养院使用的增长放缓。扣除5年MIND在家干预的费用，5年的医疗补助储蓄估计为7，052元/月，非投资回报率为1.12倍。讨论和含义管理式护理计划具有灵活性，可使残疾卫生工作者从低成本、高接触干预中受益，以满足痴呆症登记者的需求。医疗保险按服务收费中存在使用和报销社区卫生工作者的限制，CMS应解决这些限制，以最大限度地为残疾人提供福利。
Abstract Background and Objectives People with dementia (PWD) represent some of the highest-need and highest-cost individuals living in the community. Maximizing Independence (MIND) at Home is a potentially cost-effective and scalable home-based dementia care coordination program that uses trained, nonclinical community workers as the primary contact between the PWD and their care partner, supported by a multidisciplinary clinical team with expertise in dementia care. Research Design and Methods Cost of care management services based on actual time spent by care management personnel over first 12 months of MIND at Home intervention was calculated for 342 MIND at Home recipients from Baltimore, Maryland and surrounding areas participating in a Centers for Medicare and Medicaid Services (CMS) funded Health Care Innovation Award demonstration project. Difference-in-differences analysis of claims-based Medicaid spending of 120 dually-eligible MIND at Home participants with their propensity score matched comparison group (n= 360). Results The average cost per enrollee per month was 110,or 1,320 per annum. Medicaid expenditures of dually-eligible participants grew 1.12 percentage points per quarter more slowly than that of the matched comparison group. Most savings came from slower growth in inpatient and long-term nursing home use. Net of the cost of the 5-year MIND at Home intervention, 5-year Medicaid savings are estimated at 7,052perbeneficiary,a1.12-foldreturnoninvestment.DiscussionandImplicationsManagedcareplanswiththeflexibilitytoengagecommunityhealthworkerscouldbenefitfromalow-cost,high-touchinterventiontomeettheneedsofenrolleeswithdementia.LimitationsforusingandreimbursingcommunityhealthworkersexistinMedicarefee-for-service,whichCMSshouldaddresstomaximizebenefitforPWD.