Misidentification of Dementia in Medicare Claims and Related Costs
Misidentification of Dementia in Medicare Claims and Related Costs
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DOI：
10.1111/jgs.15638
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发表时间：
2019-02-01
影响因子：
6.3
通讯作者：
Stern, Yaakov
中科院分区：
文献类型：
--
作者：
Zhu, Carolyn W.;Ornstein, Katherine A.;Stern, Yaakov
目的：研究对痴呆症的错误识别如何影响对少数能够获得准确的现场诊断的参与者群体的医疗保险费用的估计。设计：前瞻性队列研究。背景：华盛顿高地-因伍德哥伦比亚老龄化项目，一项针对 65 岁及以上医疗保险受益人认知老化的多种族、基于人口的前瞻性研究。参与者：临床诊断患有痴呆症的个人 (n=495)以及临床诊断为无痴呆症的个体 (n=1,701)。 测量：医疗保险索赔确定的痴呆症是根据研究期间所有可用索赔中是否存在阿尔茨海默病和相关痴呆症的任何国际疾病分类、第九版修订版、临床修改诊断代码来定义的。使用逻辑回归估计与痴呆症索赔错误识别相关的参与者特征。使用广义线性模型估计痴呆症错误识别对医疗保险支出的影响。结果：医疗保险索赔正确识别了 495 例痴呆病例中的 250 例 (51%) 和 1,701 例非痴呆病例中的 1,565 例 (92%)。索赔识别的痴呆症的敏感性为 0.51，特异性为 0.92。临床诊断为痴呆症的受益人的平均每年医疗保险支出为 14,721 美元，而患有索赔确定的痴呆症的受益人为 18,208 美元，这表明当使用医疗保险索赔来识别痴呆症时，每人每年平均支出 3,487 美元。所有经索赔确认患有痴呆症的受益人的年度总支出比所有临床诊断的受益人低 258,707 美元，这表明如果使用 Medicare 索赔来识别痴呆症，则总体低估了 Medicare 总支出。不同类型的错误识别对痴呆症相关成本估算有不同的影响。假阳性的人均年支出最高。结论：医疗保险索赔中痴呆症的误判很常见。使用索赔来识别痴呆症可能会导致对痴呆症费用的估计存在明显偏差。
OBJECTIVES: To examine how misidentification of dementia affects estimation of Medicare costs in a largely minority cohort of participants for whom accurate in-person diagnoses are available.DESIGN: Prospective cohort study.SETTING: Washington Heights-Inwood Columbia Aging Project, a multiethnic, population-based, prospective study of cognitive aging of Medicare beneficiaries aged 65 and older.PARTICIPANTS: Individuals clinically diagnosed with dementia (n=495) and individuals clinically diagnosed without dementia (n=1,701).MEASUREMENTS: Medicare claims-identified dementia was defined according to the presence of any International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for Alzheimer's disease and related dementias in all available claims during the study period. Participant characteristics associated with claims misidentification of dementia were estimated using logistic regression. Effects of dementia misidentification on Medicare expenditures were estimated using generalized linear models.RESULTS: Medicare claims correctly identified 250 of the 495 (51%) dementia cases and 1,565 of the 1,701 (92%) nondementia cases. Sensitivity of claims-identified dementia was 0.51, and specificity was 0.92. Average annual Medicare expenditures were $14,721 for a beneficiary with a clinical diagnosis of dementia, and $18,208 for a beneficiary with claim-identified dementia, suggesting an overestimation of $3,487 per person per year when Medicare claims were used to identify dementia. Total annual expenditures for all beneficiaries with claims-identified dementia were $258,707 lower than that for all those who were clinically diagnosed, suggesting an overall underestimation of total Medicare expenditures if Medicare claims were used to identify dementia. Different types of misidentification have different effects on dementia-related cost estimates. Average annual expenditures per person were highest for false positives.CONCLUSION: Misidentification of dementia in Medicare claims is common. Using claims to identify dementia may result in significantly biased estimates of the cost of dementia.