MODELING ALZHEIMER DISEASE COSTS AND TRANSITIONS

描述(由申请人提供)：我们最近完成了一项临床试验，测试阿尔茨海默病老年初级保健中护理管理计划的有效性。基于临床试验，证明了协作护理的有效性，我们确定了对更全面护理模式的需求。这些未来的模式必须解决初级保健环境之外的多个地点和提供者的保健分散问题。为了更准确地了解整个医疗服务的整体情况，我们必须将多个医疗服务提供者、医疗保健系统和付款人之间的数据联系起来。作为临床试验招募过程的一部分，我们在初级保健中实施了全面的认知筛查和诊断计划。因此，我们现在有4197名老年初级保健患者的认知功能数据。这使我们能够将患者分为三个相互排斥的类别：痴呆症(n=147)、认知障碍(n=98)或无认知障碍(n=3952)。我们还可以通过访问高级电子医疗记录中的临床实践数据，跟踪我们的医疗保健系统中所有这些患者的护理过程、结果和成本。然而，这些临床实践数据不包括例如在家庭或熟练护理设施中提供的护理。我们现在寻求建立一个全面的数据库，将我们的临床试验和本地电子病历系统数据与联邦医疗保险索赔、医疗补助索赔和最低数据集的数据联系起来。我们研究的长期未来目标是帮助为阿尔茨海默病老年患者设计下一代护理管理干预措施。目前的项目将使我们能够确定提高质量和节省成本的目标。这种从描述性流行病学到干预性研究的进展是我们过去研究的一个标志。这个项目的具体目标是：1)为大样本的弱势老年人建立一个跨越护理连续性(家庭、门诊、住院、疗养院)的全面的纵向数据集；2)描述和比较患有痴呆症、认知障碍-非痴呆症或正常的老年人在护理过程中过渡的频率和时间；3)描述并比较患有痴呆症、认知障碍-没有痴呆症或正常的老年人在护理连续性中的护理成本；以及4)将这一城市贫困老年人队列的结果与具有全国代表性的健康与退休研究(HRS)的结果进行比较。与公共健康相关：超过450万美国人患有阿尔茨海默氏症。联邦、州和个人的财政已经很紧张，无法为目前的人口提供护理，然而，到2050年，患有阿尔茨海默氏症的老年人数量预计将增加两倍。我们的研究试图描述患有痴呆症的老年人在整个医疗保健连续体系中的护理成本和结果。这些描述性数据将有助于为新的治疗模式提供信息。

DESCRIPTION (provided by applicant): We recently completed a clinical trial testing the effectiveness of a care management program within primary care for older adults with Alzheimer's disease. Based on the clinical trial, which demonstrated the effectiveness of collaborative care, we identified the need for more comprehensive care models. These future models must address the fragmentation of care across multiple sites and providers beyond the primary care setting. To provide a more accurate picture of the entirety of care across the continuum of care, we must link data across multiple providers, health care systems, and payors. As part of the clinical trial recruitment process, we implemented a comprehensive cognitive screening and diagnosis program in primary care. Thus, we now have cognitive function data on 4,197 older primary care patients. This allows us to categorize patients into three mutually exclusive categories: dementia (n=147) cognitive impairment, no dementia (n=98); or no cognitive impairment (n=3,952). We can also track the process, outcomes, and costs of care within our health care system for all of these patients through access to clinical practice data in an advanced electronic medical record. However, these clinical practice data do not include care provided in the home or in skilled nursing facilities, for example. We now seek to establish a comprehensive database that would link our clinical trial and local electronic medical record system data with data from Medicare claims, Medicaid claims, and the Minimum Data Set. The long-range future goal of our research is to help design the next generation of care management interventions for older adults with Alzheimer's disease. The current project will allow us to identify targets for quality improvement and cost savings. This progression from descriptive epidemiologic to intervention studies is a hallmark of our past research. The specific aims of this project are to: 1) build a comprehensive longitudinal dataset across the continuum of care (home, ambulatory, inpatient, nursing home) for a large sample of vulnerable elders; 2) describe and compare the frequency and timing of transitions in care among older adults with dementia, cognitive impairment-no dementia, or normal; 3) describe and compare the costs of care across the continuum of care among older adults with dementia, cognitive impairment-no dementia, or normal; and 4) compare the findings from this cohort of urban poor older adults with findings from the nationally representative Health and Retirement Study (HRS). PUBLIC HEALTH RELEVANCE: Over 4.5 million Americans suffer from Alzheimer's disease. Federal, state, and personal finances are already strained to provide care for the current population, yet the number of older adults with Alzheimer's disease is expected to triple by 2050. Our research seeks to describe the costs and outcomes of care across the full continuum of health care for older adults with dementia. This descriptive data will help inform new treatment models.