Caregivers' Reactions and Experience: Imaging Dementia Evidence for Amyloid Scanning CARE IDEAS

护理人员的反应和经验：淀粉样蛋白扫描的痴呆症影像证据护理理念

基本信息

批准号：
9316753
负责人：
Vincent Mor
金额：
$ 147.78万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-01 至 2017-09-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9316753
关键词：
Accounting Address Advance Directives Advocate Age Aged, 80 and over Aging Agreement Alzheimer&apos s Disease American American College of Radiology Imaging Network Amyloid Behavioral Biological Markers Brain Diseases Brain Pathology Caregivers Caring Characteristics Clinical Clinical Data Clinical Management Clinical Sciences Complement Data Data Reporting Decision Making Dementia Diagnosis Diagnostic tests Disease Progression Early Diagnosis Enrollment Expenditure Future Health Health Expenditures Health Planning Healthcare Hearing Image Impaired cognition Individual Internet Intervention Interview Label Life Link Medical Medical Imaging Medicare Medicare Part A Medicare claim Memory impairment Mental Health Services Neurobehavioral Manifestations Online Systems Patient Participation Patients Persons Phase Policies Population Positive Test Result Positron-Emission Tomography Primary Care Physician Primary Health Care Provider Public Policy Reaction Recruitment Activity Reporting Research Personnel Sampling Scanning Schedule Spouse Caregiver Spouses Support System Surveys Test Result Testing United States Centers for Medicare and Medicaid Services Visit behavioral/social science beneficiary cohort coping cost demographics depressive symptoms effective therapy evidence base experience follow-up functional disability health care service utilization health literacy health service use high risk informal caregiver innovation mild cognitive impairment mortality neuropathology prevent response social treatment planning trend

项目摘要

ABSTRACT An estimated 5.3 million Americans have Alzheimer's Disease (AD) in 2015. Barring scientific innovations, the number of Americans with AD is expected to increase to over 7 million by 2025 and to 13.8 million by 2050. In 2013 the Centers for Medicare and Medicaid Services (CMS) established that amyloid PET scans would be covered under the CMS Coverage with Evidence policy and the Imaging Dementia – Evidence for Amyloid Scanning (IDEAS) study was established. IDEAS examines how amyloid PET scans can guide doctors in diagnosing AD and other dementias, early in disease progression, where the cause is ambiguous, leading to changes in clinical management. With recruitment of 18,500 Medicare beneficiaries scheduled to begin in early 2016, supplemental studies expanding on the rich clinical data are being proposed. Thus, with full support of the IDEAS Executive Committee and the Alzheimer's Association, we propose the 5 year Caregiver Reactions and Experiences – IDEAS supplemental study (CARE IDEAS). It will fill important gaps in our understanding of how spouses serving as caregivers/advocates and patients react to the results of amyloid PET scans. We propose to recruit and interview, at baseline (phone), 6-9 months (phone and web), and 18 months (phone) a sample of 3500 Medicare eligible patients and their Medicare eligible spouses from among patients in the IDEAS study with positive and negative Amyloid PET scans. Using the National Health and Aging Trends Study as the survey core, we will ask patients' about their social circumstances, behavioral consequences of memory deficits and how and why they sought to confirm a diagnosis of AD via amyloid PET. We will also characterize spouses' health literacy, the breadth and resiliency of their support system and their involvement in seeking a PET scan. Using these survey data merged with IDEAS clinical and Medicare claims data, we will: (Aim 1) estimate the relationship between a positive Amyloid PET scan and patients' receipt of Medicare reimbursed AD related diagnostic tests and health care expenditures, controlling for selected patient and spouse characteristics. Second, we will (Aim 2) estimate the effect of primary care integration and engagement with patients' earlier diagnostic testing experience on the receipt of Medicare reimbursed AD related diagnostic tests and health care expenditures in future years; Third, (Aim 3) we will estimate the effect of amyloid PET scan results on patients' participation in care and life planning at follow-up (i.e. completing advanced directives, altered medical treatment plans and undertaking estate planning), controlling for patient and spouse characteristics. Fourth, (Aim 4) we will estimate the effect of the patients' test results on spouses' symptoms of depression and mental health service use. Finally, (Aim 5) we will use a web-based survey and follow up phone calls at 6 to 9 months post-enrollment to characterize intermediate changes in medical care use, life planning and other adjustments patients and spouses attribute to hearing and understanding their amyloid PET scan test results.

抽象的 2015年，估计有530万美国人患有阿尔茨海默氏病（AD）。除了科学创新，美国人人数预计到2025年，广告将增加到700万，并增加到到2050年，有1380万。在 2013年医疗保险和医疗补助服务中心（CMS）确定淀粉样蛋白PET扫描将是在CMS覆盖范围内，具有证据政策和成像痴呆症 - 淀粉样蛋白的证据建立了扫描（思想）研究。想法考试淀粉样蛋白宠物扫描如何指导医生诊断AD和其他痴呆症，在疾病进展的早期，原因是原因是模棱两可的，导致临床管理的变化。招募计划在早期开始的18,500名Medicare受益人 2016年，正在提出有关丰富临床数据的补充研究。那在全力支持下想法执行委员会和阿尔茨海默氏症协会，我们提出了5年的照顾者反应和经验 - 思想补充研究（护理思想）。它将填补我们的理解中的重要空白配偶如何担任护理人员/倡导者和患者对淀粉样蛋白PET扫描结果的反应。我们在基线（电话），6-9个月（电话和网络）和18个月（电话）招募和面试的建议在患者中的3500名符合医疗保险的患者及其符合医疗保险资格的配偶样本想法研究正面和负淀粉样PET扫描。使用国家健康和衰老趋势作为调查核心研究，我们将向患者询问他们的社会环境，行为后果记忆定义以及他们试图通过淀粉样蛋白宠物确认AD的诊断。我们也会表征配偶的健康素养，支持系统的广度和弹性及其参与在寻求PET扫描时。使用这些调查数据与临床和医疗保险索赔数据合并的这些调查数据，我们将：（AIM 1）估计淀粉样蛋白阳性PET扫描与患者收到Medicare之间的关系报销与广告相关的诊断测试和医疗保健支出，控制选定的患者和配偶特征。其次，我们将（AIM 2）估算初级保健整合的影响和与患者收到Medicare报销广告有关的患者较早的诊断测试经验未来几年的相关诊断测试和医疗保健支出；第三，（目标3）我们将估计效果淀粉样蛋白PET扫描结果是患者参与随访中的护理和生活计划的结果（即完成高级指令，更改医疗计划和进行房地产计划），控制患者和配偶特征。第四，（目标4）我们将估计患者的测试结果对配偶的影响” 抑郁症和精神卫生服务的症状使用。最后，（目标5）我们将使用基于网络的调查，并注册后6至9个月的跟进电话，以表征医疗中的中间变化使用，生活计划和其他调整患者和配偶归因于听力和理解淀粉样蛋白PET扫描测试结果。