Advanced practice clinician care and end-of-life outcomes for community- and nursing home-dwelling Medicare beneficiaries with dementia.
Advanced practice clinician care and end-of-life outcomes for community- and nursing home-dwelling Medicare beneficiaries with dementia.
复制标题
为患有痴呆症的社区和疗养院医疗保险受益人提供先进的临床医生护理和临终结果。
DOI：
10.1002/alz.13052
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Rahman,Momotazur
中科院分区：
文献类型：
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作者：
Oh,Hyesung;White,ElizabethM;Muench,Ulrike;Santostefano,Christopher;Thapa,Bishnu;Kosar,Cyrus;Gadbois,EmilyA;Osakwe,ZainabToteh;Gozalo,Pedro;Rahman,Momotazur
患有阿尔茨海默病和相关痴呆（ADRD）的老年人经常面临繁重的临终关怀转移。高级临床医生（apc）——包括执业护士和医师助理——越来越多地为这一人群提供初级保健。为了填补目前文献的空白，我们测量了APC参与老年ADRD患者临终关怀与安宁疗护利用和住院治疗之间的关系。方法使用医疗保险数据，我们确定了2016年至2018年间死亡的ADRD疗养院（N=517,490）和社区居住（N=322,461）受益人。我们采用倾向得分加权回归方法来检验患者生命最后9个月内不同水平的APC护理与临终关怀利用和住院之间的关系。结果对于养老院和社区居住受益人，较高的APC护理参与与较低的住院率和较高的安宁疗护率相关。apc是向ADRD患者提供生命末期初级保健的重要提供者群体。对于患有ADRD的养老院和社区医疗保险受益人，在生命的最后9个月，APC护理参与比例较高的个体，调整后的住院率较低，临终关怀率较高。当考虑到初级保健访问量时，APC护理参与与调整住院率和调整安宁疗护率之间的关联仍然存在。
INTRODUCTIONOlder adults with Alzheimer's disease and related dementias (ADRD) often face burdensome end‐of‐life care transfers. Advanced practice clinicians (APCs)—which include nurse practitioners and physician assistants—increasingly provide primary care to this population. To fill current gaps in the literature, we measured the association between APC involvement in end‐of‐life care versus hospice utilization and hospitalization for older adults with ADRD.METHODSUsing Medicare data, we identified nursing home‐ (N=517,490) and community‐dwelling (N=322,461) beneficiaries with ADRD who died between 2016 and 2018. We employed propensity score‐weighted regression methods to examine the association between different levels of APC care during their final 9 months of life versus hospice utilization and hospitalization during their final month.RESULTSFor both nursing home‐ and community‐dwelling beneficiaries, higher APC care involvement associated with lower hospitalization rates and higher hospice rates.DISCUSSIONAPCs are an important group of providers delivering end‐of‐life primary care to individuals with ADRD.HIGHLIGHTSFor both nursing home‐ and community‐dwelling Medicare beneficiaries with ADRD, adjusted hospitalization rates were lower and hospice rates were higher for individuals with higher proportions of APC care involvement during their final 9 months of life.Associations between APC care involvement and both adjusted hospitalization rates and adjusted hospice rates persisted when accounting for primary care visit volume.