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

在美国开发和评估阿尔茨海默氏痴呆症监测系统

• 批准号: 10579989
• 负责人: David B Rein
• 金额: $ 56.48万
• 依托单位: NATIONAL OPINION RESEARCH CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-01 至 2027-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10579989
• 关键词: Address; Adult; Advocacy; Affect; Age; Algorithms; Alzheimer disease prevention; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; American; COVID-19 impact; COVID-19 mortality; Caring; Characteristics; Code; Cognition; Cognitive; Communities; County; Data; Data Analyses; Dementia; Diagnosis; Diagnostic; Disparity; Eligibility Determination; Ethnic Origin; Evaluation; General Population; Geography; Goals; Government; Health; Health and Retirement Study; Information Systems; Link; Long-Term Care; Low Income Population; Measures; Medicaid; Medical; Medicare; Medicare claim; Medicare/Medicaid; Methodology; Monitor; National Institute on Aging; Nongovernmental Organizations; Outcome; Patients; Persons; Population; Predictive Value; Prevalence; Public Health; Race; Research; Research Design; Research Personnel; Resources; Retirement; Sensitivity and Specificity; Services; Sexual and Gender Minorities; Source; Stratification Factors; Surveys; System; United States; Update; Work; age group; beneficiary; care systems; comorbidity; cost; data infrastructure; diagnostic value; disparity reduction; ethnic minority; fighting; health disparity; human old age (65+); improved; innovation; mortality; payment; prevent; racial minority; rural dwellers; service utilization; sex; sociodemographics; validation studies; web site

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.

项目概要/摘要 阿尔茨海默氏病和相关痴呆症 (ADRD) 影响着多达 570 万美国人，并将导致 到 2040 年，美国经济每年将达到 379 至 5000 亿美元。2020 年国家计划更新的目标 5 为了解决阿尔茨海默病问题，“改进数据以跟踪进展”，认识到需要加强对阿尔茨海默病的监测 ADRD。该目标指出，“数据和监测工作对于追踪 ADRD 的负担至关重要……并且 协助了解种族和族裔少数群体、低收入人群等人群之间的健康差异 收入人群、农村居民以及性少数群体。”没有数据或监测系统 目前存在 ADRD 监测。然而，医疗保险和医疗补助数据提供了一个有希望的来源 跟踪 ADRD 诊断的信息。医疗保险 (Medicare) 覆盖大多数 65 岁以上的美国人，而医疗补助 (Medicaid) 承保 ADRD 患者的长期护理服务。 2016年，数据基础设施委员会 国家老龄化研究所 (NIA) 确定了“减少研究人员面临的重大障碍的方法” 使用医疗保健索赔和遭遇数据”作为 NIA 的主要目标，强调了重要性和 医疗保险和医疗补助数据的价值。我们建议创建一个可公开访问的系统来 (1) 跟踪 ADRD 医疗保险和医疗补助中的诊断； (2) 进行研究以了解诊断之间的相关性 并评估痴呆症； (3) 通过使用新系统的数据来评估新系统的价值 重要的研究问题。在目标 1 中，我们建议利用一组既定的合作伙伴， 开发可公开访问的系统来监测 Medicare 中 ADRD 诊断的方法 和医疗补助，按年龄、性别、种族/民族提供国家、州和县一级的信息， 合并症、资格和其他特征和分层因素。医疗声明并不能说明所有情况 患有痴呆症的人，因此需要进行额外的研究来了解支付中蕴含的偏见 索赔信息。在目标 2 中，我们将评估 Medicare 索赔在识别人员方面的预测能力 使用来自 Medicare 和全国代表性健康和健康局的链接数据评估痴呆症 退休研究（HRS）。目标 2 将估计 Medicare 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、健康和认知因素之间的差异。最后，在 目标3，我们建议使用新的监控平台进行演示分析；估计率 医疗保险中诊断为 ADRD 的患者中的 COVID-19 死亡率。完成后，我们的系统 描述将提供急需的 ADRD 监视系统，极大地扩展访问和 为研究界和公众了解医疗保险和医疗补助 ADRD 信息。