Impact of Financial Incentives on Setting of Care for Older Adults with Alzheimer's Disease and Related Dementias

财务激励措施对患有阿尔茨海默病和相关痴呆症的老年人护理环境的影响

• 批准号: 10093198
• 负责人: Jordan M Harrison
• 金额: $ 37.51万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10093198
• 关键词: Activities of Daily Living; Admission activity; Affect; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Area; Caring; Cessation of life; Cognition; Cognitive; Communities; Data Sources; Development; Diagnosis; Elderly; Enrollment; Fee-for-Service Plans; Funding; Goals; Home Care Services; Home Nursing Care; Home environment; Impaired cognition; Incentives; Individual; Institution; Investments; Long-Term Care; Managed Care Programs; Measures; Medicaid; Medicare; Medicare/Medicaid; Memory; Modeling; Natural experiment; New York; New York City; Nursing Homes; Outcome; Patients; Phase; Policies; Public Health; Research Personnel; Retrospective cohort study; Self Care; Series; Time; beneficiary; care burden; care coordination; care systems; cognitive function; community based service; cost; design; dual eligible; exhaustion; financial incentive; functional disability; functional status; improved; neurocognitive disorder; nursing home length of stay; patient home care; policy implication; programs; service delivery; trend

Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) are irreversible neurocognitive disorders characterized by progressive decline in memory, cognition, and the ability to live independently. The public health burden of care for individuals with AD/ADRD is enormous, with national costs exceeding $277 billion in 2018, including $186 billion paid by Medicare and Medicaid. Despite such investments, coverage of home and community-based services (HCBS) is often inadequate to meet the needs of community-dwelling individuals with AD/ADRD. HCBS (e.g., home health care, personal care services) are likely to be costly than institutional care, more consistent with patient wishes, and may result in better outcomes. Greater access to HCBS may delay or replace the need for nursing home care, thus increasing the level of cognitive and functional impairment that necessitates admission to a nursing home. Many state Medicaid programs have begun to implement policies that incentivize a shift from institutional care to lower-cost HCBS. However, the impact of financial incentives on setting of care (home versus institution) for older adults with AD/ADRD is not well understood. The proposed study takes advantage of a natural experiment in New York state. Between 2012 and 2015, New York transitioned from fee-for-service delivery of HCBS to a managed long term care (MLTC) model that shifted the responsibility for costs to managed care plans. All Medicaid beneficiaries requiring more than 120 days of long term care were required to enroll in MLTC. The mandate was implemented in phases, starting in New York City and gradually expanding to other areas of the state. This natural experiment creates a unique opportunity to study the impact of financial incentives on setting of care (home versus institution) for older adults with AD/ADRD. Older adults (aged 65+) who are dually eligible for Medicare and Medicaid are affected by these incentives. Our team will leverage multiple longitudinal data sources to accomplish the following aims: 1) Describe trends in coverage and utilization of long term care services among older adults in New York state diagnosed with AD/ADRD between 2010 and 2019; 2) Evaluate changes in the intensity of home health care and nursing home care (days per year) among dual eligible older adults with AD/ADRD following implementation of MLTC mandates; 3) Evaluate changes in cognitive function and functional status (ability to perform activities of daily living) among dual eligible older adults with AD/ADRD admitted to home health care or nursing home following implementation of MLTC mandates. The goal of this new investigator-initiated R21 is to provide policymakers and other stakeholders with rigorous analyses to inform the design of financial incentives to improve delivery of long term care services for older adults with AD/ADRD. Findings will inform development of an R01 to study the impact of financial incentives on long term care utilization and outcomes among older adults with AD/ADRD across multiple states.

阿尔茨海默病和阿尔茨海默病相关性痴呆（AD/ADRD）是一种不可逆的神经认知障碍， 以记忆、认知和独立生活能力进行性下降为特征的疾病。的 AD/ADRD患者的公共卫生护理负担巨大，国家成本超过277美元 2018年，医疗保险和医疗补助支付了1860亿美元。尽管有这些投资， 家庭和社区为基础的服务（HCBS）往往不足以满足社区居民的需求， AD/ADRD患者。HCBS（例如，家庭保健、个人护理服务）可能比 机构护理，更符合病人的愿望，并可能导致更好的结果。投资者可以进一步参与 HCBS可能会延迟或取代对疗养院护理的需求，从而提高认知水平， 需要住进疗养院的功能性损伤。许多州的医疗补助计划 开始实施政策，鼓励从机构护理转向成本较低的HCBS。但 经济激励对AD/ADRD老年人护理环境（家庭与机构）的影响并不 很好理解。这项拟议中的研究利用了纽约州的一项自然实验。之间 2012年和2015年，纽约从HCBS的收费服务过渡到有管理的长期护理 （MLTC）模式，将成本责任转移到管理式护理计划。所有医疗补助受益人 需要超过120天的长期护理的患者需要参加MLTC。工作组任期 分阶段实施，从纽约市开始，逐步扩大到该州的其他地区。这 自然实验创造了一个独特的机会，研究经济激励对护理环境的影响 (home与机构相比）。符合双重资格的老年人（65岁以上） 医疗保险和医疗补助受到这些激励措施的影响。我们的团队将利用多个纵向数据 1）描述长期护理覆盖率和利用率的趋势 2010年至2019年期间，纽约州诊断为AD/ADRD的老年人中的服务; 2）评估 双重资格老年人家庭卫生保健和疗养院护理强度的变化（每年天数） 实施MLTC任务后患有AD/ADRD的成年人; 3）评估认知功能的变化 双重合格的AD/ADRD老年人的功能状态（进行日常生活活动的能力） 在执行MLTC任务后进入家庭保健或疗养院。这个目标 新的R21倡议将为决策者和其他利益相关者提供严格的分析， 告知财政激励措施的设计，以改善为老年人提供的长期护理服务， AD/ADRD。调查结果将为R 01的开发提供信息，以研究财务激励措施对长期 多个州AD/ADRD老年人的护理利用和结局。