Factors Associated with Healthcare Utilization Among Community-Dwelling Adults with Clinical Features of Dementia with Lewy Bodies

具有路易体痴呆临床特征的社区居住成年人医疗保健利用的相关因素

• 批准号: 10301251
• 负责人: Kathryn A Wyman-Chick
• 金额: $ 44.09万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10301251
• 关键词: Accident and Emergency department; Address; Adult; Adverse reactions; Alzheimer' s Disease; Antipsychotic Agents; Autonomic Dysfunction; Caregiver Burden; Caregivers; Caring; Clinical; Communities; Computerized Medical Record; Data; Data Sources; Delirium; Dementia; Dementia with Lewy Bodies; Diagnosis; Diagnostic Services; Disease; Distress; Economic Burden; Elderly; Emergency Situation; Emergency department visit; Family; Goals; Health; Hospital Costs; Hospitalization; Hospitals; Impaired cognition; Incidence; Individual; Insurance; Integrated Delivery of Health Care; Intervention; Knowledge; Length of Stay; Lewy Body Dementia; Managed Care; Medicaid; Medical; Medical Care Costs; Medicare; Mental disorders; Methods; Nursing Homes; Older Population; Outcome; Parkinsonian Disorders; Participant; Patient Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physicians; Policies; Polypharmacy; Prevalence; Provider; Psychoses; REM Sleep Behavior Disorder; Research; Research Personnel; Research Proposals; Risk; Sampling; Services; Sleep disturbances; Symptoms; System; Vascular Dementia; Visit; Visual Hallucination; adverse outcome; associated symptom; base; burden of illness; clinical decision-making; comorbidity; comparison group; cost; cost estimate; dementia care; design; detection method; early onset; experience; health care service utilization; health data; hospital readmission; hospitalization rates; improved; improved outcome; indexing; medical specialties; motor symptom; multidisciplinary; neuropsychiatric symptom; non-demented; prevent; service utilization

Project Summary The population of older adults and incidence of dementia are expected to increase significantly over the next several decades. Dementia with Lewy bodies (DLB) is the second most common form of dementia following Alzheimer’s disease (AD). DLB is a significant health burden due to high levels of caregiver stress, cognitive decline, psychiatric disorders, autonomic dysfunction, sleep disturbances, and parkinsonism. Dementia is associated with increased utilization of healthcare services compared to non-demented older adults. Individuals with DLB have significantly higher rates of hospitalizations and longer lengths of stay relative to other forms of dementia. Furthermore, patients with DLB tend to have poor outcomes following hospitalization and are more likely to be discharged from the hospital to a higher level of care than patients with AD. The goal of the research proposal is to identify modifiable factors related to increased healthcare utilization, defined as rates of hospitalization, 30-day readmissions, and emergency department visits, in patients with DLB. Ultimately, we aim to identify key factors that could be addressed to prevent distressing and costly hospitalizations and emergency visits for patients with DLB. Delays in dementia diagnosis are also correlated with increased healthcare utilization. DLB is often under recognized. Patients with undiagnosed DLB may be at increased risk of hospitalization due to the use of treatments that are contraindicated in this disorder. For example, patients with DLB often experience psychosis, but they also are more likely to have adverse reactions to antipsychotic medications relative to individuals with other dementia subtypes. Misdiagnosis in DLB is also common and may underestimate the true economic burden of DLB in existing healthcare utilization studies. The current proposal leverages Medicaid, Medicare, and commercial claims data combined with electronic medical records and random chart audits to evaluate rates of healthcare utilization for DLB compared to AD, vascular dementia, unspecified dementia, and healthy controls. To study the impact of potentially undiagnosed DLB on service utilization, this study includes a method of identifying patients with an unspecified dementia diagnosis who have been treated for core and supportive clinical features of DLB. Comorbid medical conditions, polypharmacy, multidisciplinary care, and participation in specialty diagnostic services will be investigated as possible factors related to rates of healthcare utilization among patients with DLB and other forms of dementia. Identifying factors associated with increased healthcare utilization among patients with DLB and dementia patients with clinical features of DLB is critical. Based upon the findings of this study, we will design and implement a targeted intervention within the electronic medical record to help treating providers make clinical decisions to identify undiagnosed cases, improve care, and prevent hospitalizations for patients with DLB.

项目摘要 老年人的人口和痴呆症的发病率预计将显着增加， 几十年路易体痴呆（DLB）是痴呆症的第二种最常见形式， 阿尔茨海默病（AD）。DLB是一个重大的健康负担，由于高水平的照顾者的压力，认知 衰退、精神疾病、自主神经功能障碍、睡眠障碍和帕金森氏症。 与非痴呆老年人相比，痴呆症与医疗保健服务的利用率增加有关 成年人了DLB患者的住院率显著较高，住院时间较长 相对于其他形式的痴呆症。此外，患有DLB的患者在以下情况下往往结局较差： 住院，更有可能从医院出院到更高水平的护理比病人 与AD研究提案的目标是确定与增加医疗保健相关的可改变因素 利用率，定义为住院率、30天再入院率和急诊就诊率， DLB患者最终，我们的目标是确定可以解决的关键因素，以防止令人痛苦的， DLB患者的昂贵住院和急诊。 痴呆症诊断的延迟也与医疗保健利用率的增加有关。DLB经常在 认可.由于使用药物，未确诊DLB的患者住院的风险可能会增加 这种疾病的禁忌治疗。例如，患有DLB的患者通常会经历 精神病，但他们也更有可能有不良反应，抗精神病药物相对于 患有其他痴呆亚型的人。DLB的误诊也很常见， 现有医疗保健利用研究中DLB的真实经济负担。 目前的提案利用医疗补助、医疗保险和商业索赔数据， 医疗记录和随机图表审计，以评估DLB与AD相比的医疗保健利用率， 血管性痴呆、未指明的痴呆和健康对照。为了研究潜在的未确诊的 DLB的服务利用，这项研究包括一种方法，确定患者与一个未指明的痴呆症 已接受DLB核心和支持性临床特征治疗的患者。共病医学 条件，多药，多学科护理，并参与专业诊断服务将是 研究DLB患者和其他患者中与医疗保健利用率相关的可能因素 痴呆的形式。 确定与DLB和痴呆患者的医疗保健利用增加相关的因素 具有DLB临床特征的患者至关重要。根据这项研究的结果，我们将设计和 在电子病历中实施有针对性的干预，以帮助治疗提供者进行临床 决定确定未确诊病例，改善护理，并防止DLB患者住院。