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Effect of Dementia Caregiver Interventions on Healthcare Cost

痴呆症护理人员干预对医疗费用的影响

基本信息

批准号：
8609634
负责人：
LINDA O. NICHOLS
金额：
$ 21.99万
依托单位：
UNIVERSITY OF TENNESSEE HEALTH SCI CTR
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-30 至 2016-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8609634
关键词：
Address Adoption African American Aging Alzheimer&apos s Disease Behavior Behavior Therapy Caregiver Burden Caregivers Caring Caucasians Caucasoid Race Characteristics Clinical Clinical Data Confounding Factors (Epidemiology)Cost Savings Data Dementia Economics Elderly Ethnic Origin Ethnic group Expenditure Funding Goals Health Health Care Costs Healthcare Healthcare Systems Hispanics Home environment Incentives Intervention Knowledge Latino Measures Medicare Medicare claim Mental Depression National Institute of Nursing Research National Institute on Aging Outcome Participant Patient Care Patients Physicians Quality of life Race Randomized Controlled Trials Reporting Resources Site Socioeconomic Status Time Translations Veterans Visit arm base caregiving clinical practice comparison group coping cost health care service utilization improved public health relevance racial and ethnic successful intervention therapy design treatment as usual

项目摘要

Although behavioral interventions for dementia caregivers have been shown to decrease caregiver stress and burden, there has been little examination of their effects on healthcare costs for patients or caregivers. This lack of information on interventions' impact on healthcare costs, particularly for dementia patients, has likely impeded widespread adoption of successful interventions. The proposed study addresses important knowledge gaps in our understanding of whether a successful behavioral intervention for caregivers has an impact on actual healthcare costs for patients and caregivers and whether those impacts vary based on caregiver and patient characteristics. Our main study goal is to conduct a cost identification analysis to determine if there are healthcare cost savings for dementia patients associated with their caregivers' participation in a successful behavioral intervention to improve their own coping and patient management. We will also examine whether participation in the intervention results in healthcare use and cost savings for caregivers. We propose to integrate patient and caregiver data from two previous studies of successful behavioral interventions for dementia caregivers with Medicare and VA healthcare use and cost data. The first study was the national randomized controlled trial Resources for Enhancing Alzheimer's Caregiver Health (REACH II), conducted from 2000 to 2003, with 642 caregiving dyads from 5 sites. The second study was the national clinical translation of REACH II into the Department of Veterans Affairs healthcare system, REACH VA, with 127 dyads from 29 sites, conducted from 2007-2009. For the REACH II data, half the caregivers received the behavioral intervention designed to assist with their own coping and the management of the patient's dementia related behaviors; the other half received usual care. For each patient, we will examine Medicare healthcare use (e.g., physician visits) and their associated costs for one year before the intervention, for the time during the intervention, and for one year after the intervention. Use and costs will be compared for patients whose caregivers received the intervention vs. those who did not and for caregivers who received the intervention vs. those who did not. For the REACH VA study, all caregivers received the intervention. Both VA and Medicare use and costs will be compared for the patients whose caregivers received the intervention vs. a matched comparison group of other VA patients with dementia. For all groups, we will determine if use and costs are different for different types of patients and caregivers (e.g., those of different races or ethnicities).

尽管对痴呆症照顾者的行为干预已被证明会减少照顾者压力和负担，很少有人研究它们对患者或照顾者。缺乏关于干预措施对医疗费用的影响的信息，特别是对痴呆症的影响这很可能阻碍了成功干预措施的广泛采用。建议的研究内容包括我们对照顾者是否有成功的行为干预的理解上存在重要的知识差距对患者和照顾者的实际医疗成本有影响，以及这些影响是否因护理者和患者的特征。我们的主要研究目标是进行成本识别分析，以确定是否有与照顾者相关的痴呆症患者的医疗成本节省参与成功的行为干预，提高自身应对能力和患者管理水平。我们还将检查参与干预是否会导致医疗保健使用和成本节约照顾者。我们建议整合患者和护理者的数据，这些数据来自之前两项成功的研究使用联邦医疗保险和退伍军人管理局的医疗保健使用和费用数据对痴呆症照顾者进行行为干预。第一这项研究是提高阿尔茨海默病照顾者健康的国家随机对照试验资源 (REACH II)，从2000年到2003年进行，来自5个地点的642名照顾双胞胎。第二项研究是 REACH II全国临床翻译成退伍军人事务部医疗保健系统REACH 来自29个站点的127个二联体，从2007年到2009年进行。对于REACH II的数据，一半的照顾者接受旨在帮助他们自己应对和管理的行为干预患者的痴呆相关行为；另一半接受常规护理。对于每一位患者，我们都会检查干预前一年的医疗保险保健使用(例如，医生就诊)及其相关费用，在干预期间和干预后的一年内。将对使用情况和成本进行比较照顾者接受干预的患者与未接受干预的患者和接受干预的照顾者干预VS那些没有这样做的人。在REACH VA研究中，所有照顾者都接受了干预。两者均为VA 并将对接受护理人员干预的患者的医疗保险使用情况和成本进行比较与之匹配的对照组为其他VA痴呆患者。对于所有组，我们将确定是否使用和对于不同类型的患者和照顾者(例如，不同种族或民族的人)，费用是不同的。