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

摘要 美国有600万阿尔茨海默病和相关痴呆症(ADRD)患者；这是 预计在未来30年内将增加两倍。研究表明，痴呆症患者的 医疗保健利用率。然而，痴呆症只是慢性进行性疾病的极端结局。完全 在整个认知障碍的连续体中描述医疗保健利用的模式是 对于(I)规划我们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，在认知的早期阶段更好地理解护理模式 损伤可能是至关重要的，因为对于那些疾病负担较小的人来说，修改可能更容易。 事实上，越来越多的研究表明，即使是从轻度认知开始，医疗保健利用的变化也可能开始 损害(MCI)。然而，有限的研究普遍缺乏关于认知状态的严谨数据， 过去10年至15年以上的卫生服务数据，或包括非常小的样本。因此，我们建议 评估与医疗保健利用有关的认知健康谱，包括ADRD药物和 生活(EOL)护理，在拉什阿尔茨海默病中心(RADC)正在进行的4个队列中。所有参与者都会收到 每年进行统一的认知评估和神经学检查，约90%的人进行跟踪；这包括2317次 2010-19年有关联Medicare按服务收费申请的老年人(11,000 Py的跟进：2000 Py for MCI，痴呆症1200PY)。此外，20%的参与者是非洲裔美国人(AA)，这使得最初的工作能够 认知和健康服务侧重于AAS，他们有较高的MCI和痴呆症风险；这也将建立 随着RADC AA队列继续扩大，为未来的研究提供了一个平台。简单地说，我们将比较 在每个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， 考虑到下一年对门诊和住院服务利用的不同(目标1)， 和ADRD药物处方(目标2)。目标2将重点检查参与者和疾病特征 这可能与处方填充物有关。在目标3中，我们将比较被诊断为 NCI、MCI或痴呆症。最后，虽然队列数据对于有效研究认知的连续体是必不可少的， 队列通常针对特定参与者；在目标4中，我们将通过以下方式加强队列结果的更大翻译 评估在医疗服务、ADRD药物和EOL护理方面的差异。 普通的医疗保险人口。然后，我们将根据需要应用统计方法，以在 普通医疗保险人口中的更大群体。影响：通过全面评估 医疗保健利用在整个认知过程中，我们可以开始检测获得医疗保健的各个阶段 不同的是，包括可能受到影响的护理类型。这将使有针对性的干预措施 优化卫生服务，完善未来资源规划。

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.