The impact of Medicare managed care on older patients with dementia and their family caregivers.

摘要 阿尔茨海默病和相关痴呆症（ADRD）在美国的范围是前所未有的， 影响1400万美国人，每年花费2000亿美元。1，2满足ADRD患者的需求 需要大量的长期行为和社会护理支持，而传统的收费模式通常无法提供这些支持， 服务保险由于他们的认知局限性，老年ADRD患者可能不知道其他 他们可以选择一些有潜在利益的保险。管理型护理产品可能会 改善患者的治疗效果，同时限制医疗保健的使用。通过帮助病人，这也可能减轻需要 照顾者的支持。因此，管理式护理可能为ADRD患者及其护理人员提供关键益处。 然而，很少有人知道管理式护理在痴呆症护理中的作用。重要的是要了解， 患有ADRD的老年人正在使用管理式护理产品，他们使用哪些产品，以及护理人员的作用 在这样的决定中。了解管理式护理对老年人健康结果的影响也很重要。 ADRD患者，包括使用非正式护理。考虑到痴呆症的负担，以及相关的影响， 因此，迫切需要进行研究，以弥补这些知识差距。使用纵向 医疗保险住院病人数据，加上全国调查数据，拟议的研究将使用工具变量 分析，以探索管理式护理对老年ADRD患者的影响，包括接受治疗。 创新：该赠款将是第一个严格审查管理式护理计划对结果的作用， 一种需要老年人及其家庭照顾者自我管理的衰弱性疾病。为此，它将 使用调查和索赔数据的独特和强大的组合来检查管理式护理和痴呆症的结果。 这些分析将由一个具有临床和研究专业知识的跨学科研究团队进行， 老年痴呆症护理，康复和成果测量以及政策研究的领导者。我们终于有 一个强有力的传播战略，利用我们机构资源的优势，迅速传播。 影响：该项目将利用大型国家数据集和调查与行政管理之间罕见的联系 数据为临床医生和政策制定者提供见解，以改善ADRD的覆盖率和护理策略， 和可行的方法，可以支持老年人及其非正式照顾者。它将通知保险公司 管理式医疗在满足ADRD人群需求方面的成功程度， 帮助患者和护理人员学习选择对他们的健康最有益的保险产品。

ABSTRACT The scope of Alzheimer’s disease and related Dementias (ADRD) in the United States is unprecedented, affecting 14 million Americans at an annual cost of $200 billion.1,2 Addressing the needs of patients with ADRD requires substantial long-term behavioral and social care supports not typically available under traditional fee- for-service insurance. Due to their cognitive limitations, older patients with ADRD may not know that other potentially beneficial insurance options are available to them. Managed care products may be expected to improve patient outcomes while restraining health care use. By helping patients, this might also alleviate need for caregiver support. Thus, managed care might offer critical benefits for ADRD patients and their caregivers. However, little is known about the role of managed care in dementia care. It is important to understand whether older individuals with ADRD are using managed care products, which ones they use, and the role of caregivers in such decisions. It is also important to understand the impact of managed care on health outcomes for older patients with ADRD including use of informal care. Given the burdens of dementia, and associated impacts on caregivers, there is a critical need to pursue research to address these knowledge gaps. Using longitudinal Medicare inpatient data, plus national survey data, the proposed research will use instrumental variables analysis to explore the impact of managed care on older adults with ADRD including receipt of caregiving. Innovation: The grant will be the first to rigorously examine the role of managed care programs on outcomes for a debilitating disease requiring self-management from older adults and their family caregivers. To do so, it will use a unique and robust mix of survey and claims data to examine managed care and dementia outcomes. These analyses will be conducted by an interdisciplinary study team with clinical and research expertise in dementia care, caregiving, and outcomes measurement as well as leaders in policy research. Finally, we have a robust dissemination strategy exploiting the strengths of our institutional resources for rapid dissemination. Impact: This project will leverage large national datasets and rare linkages between survey and administrative data to provide insights for clinicians and policymakers into improving coverage and care strategies for ADRD, and actionable methods that can support older individuals and their informal caregivers. It will inform insurers about the extent to which managed care is successful in addressing the needs of the ADRD population and help patients and caregivers learn select insurance products that are most beneficial for their health.