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

基本信息

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
项目类别：
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&apos s Disease Alzheimer&apos 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

项目摘要

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.

抽象的美国有600万人患有阿尔茨海默氏病和相关痴呆症（ADRD）；这是预计将在未来30年内进行三倍。研究表明，患有痴呆症的人大大增加医疗保健利用。然而，痴呆仅代表慢性进行性疾病的极端。完全表征跨认知障碍连续的医疗保健利用模式是对（i）在我们老龄化的人口中规划资源使用至关重要，以及（ii）确定护理可能的领域被修改/改进。特别是，在认知早期阶段更好地理解护理模式损害可能是至关重要的，因为对伯恩疾病较少的人来说，修改可能更容易。确实，越来越多的研究表明，即使是轻度认知，医疗保健利用的变化也可能始于损害（MCI）。但是，有限的研究通常缺乏有关认知状况的严格数据过去10 - 15年以上的健康服务数据，或包括很小的样本。那我们建议评估与医疗保健利用有关的认知健康的范围，包括ADRD药物和结束 Life（EOL）护理，在阿尔茨海默氏病中心（RADC）的4个正在进行的队列中。所有参与者都会收到年度，统一的认知评估和神经系统检查，随访90％；这包括2,317 2010 - 19年间有链接的医疗保险费用索赔的老年人（随访11,000py：2000py for MCI，痴呆症1200py）。此外，有20％的参与者是非裔美国人（AA），以实现最初的工作认知和卫生服务集中在AAS中，他们患有MCI和痴呆症的风险很高；这也将建立随着RADC AA队列的不断扩大，未来研究的平台。简而言之，我们将比较在每次年度评估中，参与者被诊断为没有认知障碍（NCI），MCI和痴呆症，考虑到后期使用门诊和住院服务的差异（AIM 1），和ADRD药物处方填充（AIM 2）。 AIM 2将专注于检查参与者和疾病特征这可能与处方填充有关。在AIM 3中，我们将在决定诊断方面的EOL护理与 NCI，MCI或痴呆症。最后，尽管队列数据对于有效研究认知连续体至关重要，但队列通常针对特定的参与者；在AIM 4中，我们将通过评估RADC参与者与RADC参与者之间的健康服务，ADRD药物和EOL护理的任何差异普通医疗保险人口。然后，我们将根据需要应用统计方法来“模仿”我们的结果大型医疗保险人口的较大群体。影响：通过全面评估跨认知连续性的医疗保健利用，我们可以开始检测访问护理的阶段差异化，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优化卫生服务，并改善未来的资源计划。