Effect of Dementia Caregiver Interventions on Healthcare Cost

描述（由申请人提供）：虽然痴呆症照顾者的行为干预已被证明可以减少照顾者的压力和负担，但很少检查其对患者或照顾者医疗保健费用的影响。缺乏关于干预措施对医疗保健费用影响的信息，特别是对痴呆症患者的影响，可能阻碍了成功干预措施的广泛采用。这项拟议的研究解决了我们理解的重要知识差距，即对照顾者的成功行为干预是否会影响患者和照顾者的实际医疗费用，以及这些影响是否会因照顾者和患者的特征而异。我们的主要研究目标是进行成本识别分析，以确定是否有医疗保健成本节约痴呆症患者与他们的照顾者参与成功的行为干预，以改善自己的应对和病人的管理。我们还将研究参与干预是否会导致护理人员的医疗保健使用和成本节约。我们建议整合患者和照顾者的数据，从两个以前的研究成功的行为干预痴呆症照顾者与医疗保险和VA医疗保健的使用和成本数据。第一项研究是2000年至2003年进行的国家随机对照试验“增强阿尔茨海默氏症护理人员健康的资源”（REACH II），来自5个地点的642个配对。第二项研究是将REACH II转化为退伍军人事务部医疗保健系统REACH VA的国家临床翻译，2007-2009年进行了29个研究中心的127对研究。对于REACH II数据，一半的照顾者接受了旨在帮助他们自己应对和管理患者痴呆相关行为的行为干预;另一半接受了常规护理。对于每一个病人，我们将检查医疗保险的医疗保健使用（例如，医生就诊）及其相关费用，包括干预前一年、干预期间和干预后一年的费用。将比较护理人员接受干预的患者与未接受干预的患者以及护理人员接受干预的患者与未接受干预的患者的使用和成本。对于REACH VA研究，所有护理人员都接受了干预。将比较其护理人员接受干预的患者与其他VA痴呆患者的匹配对照组的VA和医疗保险使用和成本。对于所有组，我们将确定不同类型的患者和护理人员的使用和成本是否不同（例如，不同种族或民族）。

DESCRIPTION (provided by applicant): 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).