A National Analysis of Observation Care Among Medicare Beneficiaries with Alzheimer's Disease and Related Dementias

急诊科（艾德）就诊在美国很常见，大约五分之一 美国人每年至少访问艾德一次。老年人，特别是那些 阿尔茨海默病和相关痴呆症（ADRD），使用艾德的比率较高， 甚至更大的不良后果的风险。拥挤的艾德条件可能会造成特定的安全风险 对于那些认知受损的人来说。观察室护理已被提议作为一种解决方案， 紧急护理的时间紧迫性。事实上，近年来， 多年来，在使用观察护理的老年人提出的ED。然而，有关注 观察停留可能不适合某些患者，并且可能与 与传统的住院治疗相比，结果较差。有证据表明，观察 当仅限于针对特定条件的协议化护理时，护理产生最佳结果。然而 大多数观察护理不是在这种结构化的环境中提供的。因此， 观察治疗可能不是主要的治疗方法，特别是对于患有 阿尔茨海默氏病和相关痴呆症（ADRD），谁更经常出现在艾德与 不太明确的非特异性症状和状况。然而，现代的证据 缺乏对成人ADRD患者的观察护理。我们将使用国家医疗保险 要求检查医疗保险观察护理的利用率和强度的趋势 ADRD的受益者。我们将使用一种新的方法来评估某些 医院一直在用住院治疗、直接艾德出院或 两者此外，我们将描述与以下因素相关的临床结局趋势： 为ADRD受益人提供观察护理。我们将使用医疗保险索赔来确定 与这些结果相关的患者、医院和区域水平变量。我们将 使用国家医疗保险索赔分析的结果来开发风险预测工具， 一线临床医生对ADRD受益人进行风险分层，以确定与以下相关的不良结局： 观察护理。这项全国性的纵向研究将使一线临床医生能够更好地定制 根据ADRD患者的需要采用观察护理。

Emergency department (ED) visits are common in the United States, with approximately 1 in 5 Americans visiting the ED at least once per year. Older adults, particularly those with Alzheimer’s Disease and Related Dementias (ADRD), use the ED at higher rates and have an even greater risk of adverse outcomes. Crowded ED conditions may pose particular safety risks for those with impaired cognition. Observation unit care has been proposed as a solution to the time-pressured nature of emergency care. Indeed, there has been a marked growth in recent years in the use of observation care for older adults presenting to the ED. Yet, there is concern that observation stays may be inappropriate for some patients and may be associated with poorer outcomes compared to a traditional inpatient stay. Evidence suggests that observation care yields the best outcomes when limited to protocolized care for specific conditions. Yet, the majority of observation care is not provided in such structured settings. Thus, the ideal model of observation care is likely not the predominant one, particularly for the population of patients with Alzheimer’s disease and related dementias (ADRD), who more often present to the ED with nonspecific symptoms and conditions that are less well-defined. Yet, evidence on the modern landscape of observation care for adults with ADRD is lacking. We will use national Medicare claims to examine trends in the utilization and intensity of observation care for Medicare beneficiaries with ADRD. We will use a novel approach to evaluate the degree to which certain hospitals have been substituting observation stays for inpatient care, direct ED discharge or both. Furthermore, we will characterize the trends in clinical outcomes associated with observation care for beneficiaries with ADRD. We will use Medicare claims to identify the patient, hospital and regional-level variables that are associated with these outcomes. We will use the findings from analyses of national Medicare claims to develop a risk-prediction tool for frontline clinicians to risk-stratify beneficiaries with ADRD for adverse outcomes associated with observation care. This national, longitudinal study will enable frontline clinicians to better tailor the use of observation care to the needs of patients with ADRD.