Developing and Evaluating a Surveillance System for Alzheimer's Dementia In the United States

项目摘要/摘要 阿尔茨海默病和相关痴呆症(ADRD)影响着多达570万美国人，并将使 到2040年，美国经济每年将达到379亿至5000亿美元。《国家计划》2020年更新的目标5 为了解决阿尔茨海默氏症，“改善数据以跟踪进展”，认识到有必要加强对 阿德勒。目标是，“数据和监测工作对于追踪ADRD…和 帮助了解人口之间的健康差距，如种族和少数民族、低 收入人口、农村居民、性少数和性别少数。 目前存在对ADRD的监视。然而，医疗保险和医疗补助数据提供了一个有希望的来源 用于跟踪ADRD诊断的信息。联邦医疗保险覆盖了大多数65岁以上的美国人，医疗补助 为ADRD患者提供长期护理服务。2016年，中国移动数据基础设施委员会 美国国家老龄研究所(NIA)确定了“减少研究人员在 使用医疗保健索赔和遭遇数据“作为NIA的主要目标，强调 医疗保险和医疗补助数据的价值。我们建议创建一个公众可访问的系统来(1)跟踪ADRD 医疗保险和医疗补助中的诊断；(2)进行研究，了解诊断出的 和评估痴呆症；以及(3)通过使用其数据评估 重要的研究问题。在目标1中，我们建议利用现有的合作伙伴和 开发一个公众可访问的系统来监测和监测联邦医疗保险中的ADRD诊断的方法 和医疗补助，提供国家、州和县一级的信息，并按年龄、性别、种族/民族、 合并症、合并症、合格率等特点及分层因素。医疗索赔并不能确定所有 患有痴呆症的人，所以需要更多的研究来理解支付中嵌入的偏见 索赔信息。在目标2中，我们将评估医疗保险索赔在识别个人身份方面的预测能力 使用Medicare和全国代表性的健康和健康中心的关联数据评估痴呆症 退休研究(HRS)。目标2将评估医疗保险索赔在检测HRS方面的敏感性和特异性 评估痴呆症，并探索社会人口统计、健康和认知因素的差异。最后，在 目标3，我们建议使用新的监控平台进行实证分析；估算率 在联邦医疗保险中，被诊断为ADRD的患者中新冠肺炎死亡率的比例。当完成时，系统我们 Describe将提供急需的ADRD监视系统，极大地扩大访问和 为研究界和普通公众了解Medicare和Medicaid ADRD信息。

PROJECT SUMMARY/ABSTRACT Alzheimer's disease and related dementias (ADRD) affect as many as 5.7 million Americans and will cost the U.S. economy between $379 and $500 billion per year by 2040. Goal 5 of the 2020 update to the National Plan to Address Alzheimer's, "Improve data to track progress", recognizes the need for increased surveillance of ADRD. The goal states, "Data and surveillance efforts are paramount to tracking the burden of ADRD … and assist with understanding health disparities among populations such as racial and ethnic minorities, low- income populations, rural residents, and sexual and gender minorities." No data or surveillance system currently exists for ADRD surveillance. However, Medicare and Medicaid data offer a promising source of information to track ADRD diagnoses. Medicare covers most Americans over the age of 65, and Medicaid covers long-term care services for people with ADRD. In 2016, the Data Infrastructure Committee of the National Institute on Aging (NIA) identified "ways to reduce the significant obstacles faced by researchers in using medical care claims and encounter data" as a primary NIA objective, highlighting the importance and value of Medicare and Medicaid data. We propose to create a publicly accessible system to (1) track ADRD diagnoses in Medicare and Medicaid; (2) conduct research to understand the correlation between diagnosed and assessed dementia; and (3) demonstrate the value of the new system by using its data to evaluate an important research question. In Aim 1, we propose to leverage an established set of partners and methodologies to develop a publicly accessible system to monitor and surveil ADRD diagnoses in Medicare and Medicaid, providing information at the national, state and county level and by age, sex, race/ethnicity, comorbidity, eligibility and other characteristics and stratification factors. Medical claims do not identify all persons living with dementia, so additional research is needed to understand the biases embedded in payment claims information. In Aim 2, we will evaluate the predictive power of Medicare claims in identifying persons with assessed dementia using linked data from Medicare and the nationally representative Health and Retirement Study (HRS). Aim 2 will estimate the sensitivity and specificity of Medicare claims in detecting HRS assessed dementia and explore differences across sociodemographic, health, and cognitive factors. Finally, in Aim 3, we propose to use the new surveillance platform to perform a demonstration analysis; estimating rates of COVID-19 mortality among patients diagnosed with ADRD in Medicare. When completed, the system we describe will provide a much-needed ADRD surveillance system, vastly expanding access to and understanding of Medicare and Medicaid ADRD information for the research community and general public.