Attributable Cost of Dementia: Demonstrating Pitfalls of Ignoring Multiple Health Care System Utilization
Attributable Cost of Dementia: Demonstrating Pitfalls of Ignoring Multiple Health Care System Utilization
复制标题
DOI：
10.1111/1475-6773.13048
复制
发表时间：
2018-12-01
影响因子：
3.4
通讯作者：
Intrator, Orna
中科院分区：
文献类型：
--
作者：
Lei, Lianlian;Cooley, Susan G.;Intrator, Orna
目的利用退伍军人健康管理局（VHA）的数据，包括和不包括医疗保险数据，确定痴呆症的患病率和可归因于痴呆症的成本。数据来源VHA住院、门诊、购买的护理和其他数据以及2013财政年度（FY）的医疗保险登记、索赔和评估。研究设计分析单独使用VHA数据，并结合VHA和Medicare数据。痴呆症是从VHA认可的ICD-9诊断清单中确定的。痴呆的可归因成本使用循环预测估计。2013财年，65岁及以上使用VHA并参加传统医疗保险的退伍军人（190万）。VHA记录显示，2013财年痴呆症的患病率为4.8%，而VHA和Medicare数据显示患病率为7.4%。单独使用VHA，每位退伍军人的痴呆症可归因成本平均为每年10,950美元，而使用VHA和医疗保险数据的综合成本为每年6,662美元。VHA和Medicare的痴呆归因成本合计为11,285美元/年。单独使用VHA数据归因于痴呆症的使用率在长期机构中较低，而在支持性护理服务中高于VHA和Medicare数据的综合显示。更好地规划临床和成本效益的护理需要VHA和Medicare共享痴呆症退伍军人的数据，可能更广泛。
Objectives To determine dementia prevalence and costs attributable to dementia using Veterans Health Administration (VHA) data with and without Medicare data. Data Sources VHA inpatient, outpatient, purchased care and other data and Medicare enrollment, claims, and assessments in fiscal year (FY) 2013. Study Design Analyses were conducted with VHA data alone and with combined VHA and Medicare data. Dementia was identified from a VHA sanctioned list of ICD-9 diagnoses. Attributable cost of dementia was estimated using recycled predictions. Data Collection Veterans age 65 and older who used VHA and were enrolled in Traditional Medicare in FY 2013 (1.9 million). Principal Findings VHA records indicated the prevalence of dementia in FY 2013 was 4.8 percent while combined VHA and Medicare data indicated the prevalence was 7.4 percent. Attributable cost of dementia to VHA was, on average, $10,950 per veteran per year (pvpy) using VHA alone and $6,662 pvpy using combined VHA and Medicare data. Combined VHA and Medicare attributable cost of dementia was $11,285 pvpy. Utilization attributed to dementia using VHA data alone was lower for long-term institutionalization and higher for supportive care services than indicated in combined VHA and Medicare data. Conclusions Better planning for clinical and cost-efficient care requires VHA and Medicare to share data for veterans with dementia and likely more generally.