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

在老年人认知健康和衰退的整个连续体中使用医疗保健

• 批准号: 10710168
• 负责人: Julie PW Bynum
• 金额: $ 62.59万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10710168
• 关键词: Affect; African American; African American population; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Behavioral; Caring; Categories; Cessation of life; Characteristics; Chronic; Classification; Clinical; Cognition; Cognitive; Cognitive aging; Data; Dementia; Development; Diagnosis; Disease; Drug Prescriptions; Elderly; Eligibility Determination; Emergency department visit; Epidemiology; Evaluation; Expenditure; Fee-for-Service Plans; Future; Geriatrics; Grant; Health; Health Services; Health Services Research; Healthcare; Hospitalization; Hospitals; Impaired cognition; Individual; Intervention; Investigation; Link; Measures; Medicare; Medicare claim; Modification; Neurologic; Neurology; Neuropsychology; Participant; Pattern; Patterns of Care; Pharmaceutical Preparations; Population; Race; Research; Resources; Sampling; Services; Severities; Statistical Methods; Surveys; Time; Translations; Visit; Work; aging population; burden of illness; cognitive testing; cohort; comorbidity; cost; end of life care; follow-up; functional disability; health care service utilization; health difference; health management; health service use; high risk; hospice environment; improved; inpatient service; mild cognitive impairment; minority health; novel; outpatient programs; prospective; sex; social

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.

抽象的 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 预计未来 30 年将增加两倍。研究表明，痴呆症患者的患病率要高得多 医疗保健利用。然而，痴呆症仅代表慢性进行性疾病的极端情况。完全 描述认知障碍连续过程中医疗保健利用模式的特征是 对于 (i) 规划老龄化人口的资源使用，以及 (ii) 确定可以提供护理的领域至关重要 被修改/改进。特别是，更好地了解认知早期阶段的护理模式 损伤可能至关重要，因为对于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，即使是轻度认知，医疗保健利用率也可能开始发生变化。 损伤（MCI）。然而，有限的研究通常缺乏关于认知状态的严格数据，整合 过去 10-15 年以上的卫生服务数据，或包含非常小的样本。因此，我们建议 评估与医疗保健利用相关的认知健康范围，包括 ADRD 药物和治疗结束 生命 (EOL) 护理，在 Rush 阿尔茨海默病中心 (RADC) 的 4 个正在进行的队列中进行。所有参与者都会收到 每年进行统一的认知评估和神经系统检查，随访率约 90%；这包括 2,317 2010-19 年期间与 Medicare 服务费相关的老年人（后续 11,000PY：2000PY MCI，痴呆症 1200PY）。此外，20% 的参与者是非裔美国人 (AA)，这使得初步工作得以开展 认知和健康服务重点关注 AA，他们患有 MCI 和痴呆症的风险较高；这也将建立 随着 RADC AA 队列的不断扩大，该平台成为未来研究的平台。简而言之，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 和痴呆症的参与者， 考虑到下一年他们对门诊和住院服务的利用情况存在差异（目标 1）， 并填写 ADRD 药物处方（目标 2）。目标 2 将重点检查参与者和疾病特征 这可能与处方配药有关。在目标 3 中，我们将比较诊断患有以下疾病的死者的 EOL 护理 NCI、MCI 或痴呆症。最后，虽然队列数据对于有效研究认知连续体至关重要， 群体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转化： 评估 RADC 参与者与 RADC 参与者之间在卫生服务、ADRD 药物和 EOL 护理方面的差异 一般医疗保险人群。然后，我们将根据需要应用统计方法来“模仿”我们的结果 一般医疗保险人群中较大的群体。影响：通过综合评估差异 跨越认知连续体的医疗保健利用，我们可以开始检测获得护理的阶段 区别对待，包括可能受到影响的护理类型。这都将为有针对性的干预措施提供信息 优化卫生服务，改善未来资源规划。