Personality and Health Services Use and Expenditures of Older Persons

老年人的性格和健康服务使用和支出

• 批准号: 7989552
• 负责人: BRUCE FRIEDMAN
• 金额: $ 7.7万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2011-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7989552
• 关键词: Accident and Emergency department; Acute; Address; Age; Ambulatory Care; Area; Attitude; Behavior; Belief; Caring; Categories; Characteristics; Chronic; Clinical; Clinical Trials; Communities; Confidence Intervals; Consensus; Data; Decision Making; Development; Dimensions; Education; Effectiveness; Elderly; Equipment and supply inventories; Expenditure; Health Policy; Health Services; Health Services Research; Health Status; Healthcare; Hospitalization; Hour; Human; Individual; Influenza vaccination; Intervention; Journals; Lead; Length of Stay; Linear Models; Literature; Long-Term Care; Medicare; Medicare claim; Mental Health Services; Methods; Modeling; Neurotic Disorders; Outcome; Personality; Persons; Problem Solving; Public Health; Public Policy; Research; Research Design; Role; Sampling; Scholarship; Services; United States Centers for Medicare and Medicaid Services; Vaccination; Visit; Visiting Nurse; base; beneficiary; community intervention; cost; design; experience; health care service utilization; negative emotional state; novel; nursing home length of stay; patient home care; policy implication; programs; public health relevance; symposium

DESCRIPTION (provided by applicant): The presence of extremely high healthcare expenditures per capita, including for elderly persons, is a major clinical, public health, and public policy problem in the U.S. The lack of efficiency in U.S. healthcare is directly related to extensive overuse of discretionary services as well as to substantial underuse of effective non-discretionary services. If personality is associated with healthcare use and expenditures in later life, then it could be a critical factor in the development of targeted and tailored interventions to address over- and underuse. However, it is not known whether personality is associated with healthcare expenditures. This study will establish whether this relationship exists. If the relationship exists, the long-term objective of this resubmitted R03 secondary analysis will be a program of research to develop interventions that take advantage of personality domains to address overuse and underuse among Medicare beneficiaries. An extensive literature shows that health status, beliefs, attitudes, and behaviors and healthcare decision-making are all related to personality. There is strong consensus that the major dimensions of human personality can be grouped into 5 broad domains known as the "Big Five": Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. The Big Five will be assessed using the NEO-Five Factor Inventory (NEO-FFI). While 9 studies have found an association between personality domains and health services use, only one included exclusively persons age 65 and older, and 5 of the 9 focused on mental health services. The Specific Aims are to establish if associations exist between personality domains and (1) Medicare, non-Medicare, and total healthcare expenditures, (2) 4 of the most expensive acute and long term care services (acute hospital days, emergency department visits, nursing home days, and custodial home care hours), and (3) high versus low discretionary healthcare services. The data were collected from 1308 community-dwelling Medicare beneficiaries participating in the Medicare Primary and Consumer-Directed Care Demonstration. A large part of the study's significance derives from the sample, which is made up of groups (lower SES/education) that rarely participate in intensive research. Outcome variables are expenditures calculated from utilization data collected via daily Health Care Journals for 30 healthcare services (Aim 1), categories of utilization obtained from these daily Journals (Aim 2), and Medicare claims data provided by the Centers for Medicare and Medicaid Services (Aim 3). Utilization will be estimated by negative binomial, two- part, and/or hurdle regression models. Two-part generalized linear models will be employed for expenditures. Standard errors and 95% confidence intervals will be estimated using clustered non-parametric bootstrap methods. The establishment of associations between personality and healthcare use or expenditures will lead to studies designed to establish causal mechanisms and ultimately to interventions that are targeted or tailored to characteristics of individuals that overuse discretionary or underuse effective non-discretionary services. PUBLIC HEALTH RELEVANCE: The proposed study is highly relevant to public health because overuse of some discretionary healthcare services and underuse of effective, readily available, non-discretionary services represent major public policy problems and potential threats to public health, especially for Medicare beneficiaries. The public health and policy implications of the relationship between personality and healthcare use and expenditures in later life have rarely, if ever, been considered. If we are able to show associations between personality domains and healthcare use and expenditures, we anticipate convening a conference to explore the clinical, public health, and policy implications of the role of personality for healthcare services utilization and expenditures in order to be able to develop clinical trials to investigate targeted and tailored interventions and community-based translational effectiveness studies to reduce overuse of discretionary healthcare services and increase underuse of effective non-discretionary services.

描述(由申请人提供)：包括老年人在内的人均医疗支出极高，是美国临床、公共卫生和公共政策的主要问题。美国医疗保健缺乏效率直接与过度使用可自由支配的服务以及严重不足有效的非可自由支配服务有关。如果个性与晚年的医疗保健使用和支出有关，那么它可能是制定有针对性和量身定做的干预措施以解决过度使用和使用不足的关键因素。然而，目前尚不清楚个性是否与医疗支出有关。这项研究将确定这种关系是否存在。如果存在这种关系，重新提交的R03二级分析的长期目标将是一个研究计划，以开发利用人格领域的干预措施，以解决医疗保险受益人中过度使用和使用不足的问题。大量文献表明，健康状况、信念、态度、行为和保健决策都与个性有关。人们一致认为，人类人格的主要维度可以分为五大领域，即神经质、外向、开放体验、随和和尽职尽责。五大将使用新五因素清单(NEO-FFI)进行评估。虽然有9项研究发现人格领域与健康服务使用之间存在关联，但只有一项研究专门包括65岁及以上的人，9项研究中有5项专注于精神健康服务。具体目标是确定个性领域与(1)联邦医疗保险、非联邦医疗保险和医疗总支出之间是否存在关联，(2)4种最昂贵的急性和长期护理服务(急性住院日、急诊科就诊、疗养院日和监护家庭护理时间)，以及(3)高与低可自由支配的医疗服务。这些数据是从1308名社区居住的联邦医疗保险受益人那里收集的，这些受益人参加了联邦医疗保险初级和消费者导向医疗示范。这项研究的很大一部分意义来自样本，样本由很少参与密集研究的群体(较低的社会经济地位/教育程度)组成。结果变量是根据通过每日医疗保健期刊收集的30项医疗服务的利用数据计算的支出(目标1)、从这些每日日记获得的利用类别(目标2)以及由医疗保险和医疗补助服务中心提供的医疗保险索赔数据(目标3)。使用率将通过负二项、两部分和/或栅栏回归模型进行估计。支出将采用两部分广义线性模型。标准误差和95%的可信区间将使用集群化的非参数自举方法来估计。建立个性与医疗使用或支出之间的联系将导致旨在建立因果机制的研究，并最终产生针对过度使用可自由支配或未充分使用有效非可自由支配服务的个人特征的干预措施。 公共卫生相关性：拟议的研究与公共健康高度相关，因为过度使用一些可自由支配的医疗服务和未充分使用有效的、随时可用的非可自由支配的服务代表着重大的公共政策问题和对公共健康的潜在威胁，特别是对联邦医疗保险受益人来说。人格与晚年医疗保健使用和支出之间的关系对公共健康和政策的影响很少被考虑，如果曾经考虑过的话。如果我们能够显示个性领域与医疗使用和支出之间的关联，我们预计将召开一次会议，探讨个性对医疗服务利用和支出的临床、公共卫生和政策影响，以便能够开发临床试验，调查有针对性的定制干预措施和基于社区的转换有效性研究，以减少过度使用可自由支配的医疗服务，并增加有效的非可自由支配服务的使用不足。