Use of Healthcare Across the Full Continuum of Cognitive Health and Decline in Older Adults

摘要 在美国，有超过600万人患有阿尔茨海默病和相关痴呆症（ADRD）;这是一个巨大的数字。 预计在未来30年内将增长三倍研究表明，那些患有痴呆症的人 保健利用。然而，痴呆症只是慢性进行性疾病的极端。充分 在认知障碍的连续体中，医疗保健利用的特征模式是 关键是（i）规划我们老龄化人口的资源使用，以及（ii）确定护理可能 修改/改进。特别是，更好地了解认知早期阶段的护理模式， 损伤可能是至关重要的，因为对于那些疾病负担较轻的人来说，修改可能更容易。 事实上，越来越多的研究表明，医疗保健利用的变化可能开始，即使是轻度认知障碍， 损害（MCI）。然而，有限的研究通常缺乏关于认知状态的严格数据， 过去10-15年以上的保健服务数据，或包括非常小的样本。因此，我们建议 评估与医疗保健利用相关的认知健康谱，包括ADRD药物和治疗结束 生命（EOL）护理，在拉什阿尔茨海默病中心（RADC）的4个正在进行的队列中。所有参与者将获得 每年进行一次统一的认知评估和神经系统检查，随访率约为90%;这包括2，317例 2010- 2019年，有关联Medicare按服务付费索赔的老年人（11，000 PY随访：2000 PY MCI，1200 PY用于痴呆）。此外，20%的参与者是非洲裔美国人（AA）， 认知和健康服务集中在AA，谁有MCI和痴呆症的高风险;这也将建立 作为未来研究的平台，RADC AA队列继续扩大。简单地说，我们将比较 在每次年度队列评估中被诊断为无认知障碍（NCI）、MCI和痴呆的参与者， 考虑到他们在随后一年使用门诊和住院服务的差异（目标1）， 和ADRD药物处方填充（目标2）。目标2将侧重于检查参与者和疾病特征 可能与处方药有关在目标3中，我们将比较诊断为以下疾病的死者的EOL护理： NCI、MCI或痴呆。最后，虽然队列数据对于有效研究认知连续体至关重要， 队列通常针对特定的参与者;在目标4中，我们将通过以下方式加强队列研究结果的更大翻译 评估RADC参与者与 一般的医疗服务。然后，我们将根据需要应用统计方法来“模拟”我们的结果， 更大的群体的一般医疗保险的人口。影响：通过全面评估 通过认知连续体中的医疗保健利用，我们可以开始检测获得医疗保健的阶段 差异，包括可能受到影响的护理类型。这将为有针对性的干预提供信息， 优化卫生服务，改善未来资源规划。

ABSTRACT There are >6 million individuals with Alzheimer’s disease and related dementias (ADRD) in the US; this is predicted to triple in the next 30 years. Research indicates that those with dementia have substantially greater healthcare utilization. Yet, dementia represents only the extreme end of a chronic progressive disorder. Fully characterizing patterns of healthcare utilization across the continuum of cognitive impairment is critical to (i) planning resource use in our aging population, and (ii) identifying areas where care might be modified/improved. In particular, better understanding care patterns in early stages of cognitive impairment could be crucial since modifications may be easier for those with less disease burden. Indeed, growing research suggests changes in healthcare utilization may begin even with mild cognitive impairment (MCI). However, the limited studies generally lack either rigorous data on cognitive status, integrate health services data from 10-15+ years in the past, or include very small samples. Thus, we propose to evaluate the spectrum of cognitive health in relation to healthcare utilization, including ADRD drugs and end of life (EOL) care, in 4 ongoing cohorts at the Rush Alzheimer’s Disease Center (RADC). All participants receive annual, harmonized cognitive assessments and neurologic exams, with ~90% followup; this includes 2,317 older individuals with linked Medicare fee-for-service claims from 2010-19 (11,000PY of followup: 2000PY for MCI, 1200PY for dementia). Further, 20% of participants are African American (AA), enabling initial work on cognition and health services focused in AAs, who have high risk of MCI and dementia; this will also establish a platform for future research as the RADC AA cohort continues to expand. Briefly, we will compare participants diagnosed as no cognitive impairment (NCI), MCI, and dementia at each annual cohort evaluation, considering differences in the subsequent year in their utilization of outpatient and inpatient services (Aim 1), and ADRD drug prescription fills (Aim 2). Aim 2 will focus on examining participant and disease characteristics that may be related to prescription fills. In Aim 3, we will compare EOL care across decedents diagnosed with NCI, MCI or dementia. Finally, while cohort data are essential to validly studying the continuum of cognition, cohorts often target specific participants; in Aim 4, we will enhance larger translation of cohort findings by assessing any differences in health services, ADRD drugs, and EOL care between RADC participants versus the general Medicare population. We will then apply statistical methods, as needed, to “mimic” our results in larger groups of the general Medicare population. Impact: By comprehensively evaluating differences in healthcare utilization across the continuum of cognition, we can begin to detect stages where care is accessed differentially, including types of care which may be affected. This will both inform targeted interventions to optimize health services, and improve future resource planning.