MODELING ALZHEIMER DISEASE COSTS AND TRANSITIONS

描述（由申请人提供）：我们最近完成了一项临床试验，测试了老年阿尔茨海默病初级保健中护理管理程序的有效性。基于临床试验，它证明了协作治疗的有效性，我们确定需要更全面的治疗模式。这些未来的模式必须解决初级保健设置之外的多个站点和提供者之间的护理碎片化问题。为了更准确地了解整个护理过程的整体情况，我们必须将多个提供者、卫生保健系统和付款人之间的数据联系起来。作为临床试验招募过程的一部分，我们在初级保健中实施了全面的认知筛查和诊断计划。因此，我们现在有4197名老年初级保健患者的认知功能数据。这使我们能够将患者分为三种相互排斥的类别：痴呆症（n=147）认知障碍，无痴呆症（n=98）；或无认知障碍（n= 3952）。我们还可以通过访问先进的电子病历中的临床实践数据，在我们的医疗保健系统中跟踪所有这些患者的护理过程、结果和成本。然而，这些临床实践数据不包括例如在家中或在熟练护理机构提供的护理。我们现在寻求建立一个全面的数据库，将我们的临床试验和本地电子医疗记录系统数据与医疗保险索赔、医疗补助索赔和最低数据集的数据联系起来。我们研究的长远目标是帮助设计下一代老年痴呆症患者的护理管理干预措施。当前的项目将使我们能够确定质量改进和成本节约的目标。从描述性流行病学研究到干预研究的进展是我们过去研究的一个标志。该项目的具体目标是：1)为大量脆弱的老年人样本建立一个全面的纵向数据集，涵盖护理连续体（家庭，门诊，住院，养老院）；2)描述并比较老年痴呆、认知障碍（无痴呆或正常）老年人护理转变的频率和时间；3)描述并比较患有痴呆症、认知障碍（无痴呆症或正常）的老年人的连续护理成本；4)将这组城市贫困老年人的研究结果与具有全国代表性的健康与退休研究（HRS）的研究结果进行比较。公共卫生相关性：超过450万美国人患有阿尔茨海默病。联邦政府、州政府和个人的财政状况已经很紧张，无法为目前的人口提供护理，然而，到2050年，患有阿尔茨海默病的老年人数量预计将增加两倍。我们的研究旨在描述老年痴呆症患者在整个医疗保健连续体中的护理成本和结果。这些描述性数据将有助于建立新的治疗模式。

DESCRIPTION (provided by applicant): We recently completed a clinical trial testing the effectiveness of a care management program within primary care for older adults with Alzheimer's disease. Based on the clinical trial, which demonstrated the effectiveness of collaborative care, we identified the need for more comprehensive care models. These future models must address the fragmentation of care across multiple sites and providers beyond the primary care setting. To provide a more accurate picture of the entirety of care across the continuum of care, we must link data across multiple providers, health care systems, and payors. As part of the clinical trial recruitment process, we implemented a comprehensive cognitive screening and diagnosis program in primary care. Thus, we now have cognitive function data on 4,197 older primary care patients. This allows us to categorize patients into three mutually exclusive categories: dementia (n=147) cognitive impairment, no dementia (n=98); or no cognitive impairment (n=3,952). We can also track the process, outcomes, and costs of care within our health care system for all of these patients through access to clinical practice data in an advanced electronic medical record. However, these clinical practice data do not include care provided in the home or in skilled nursing facilities, for example. We now seek to establish a comprehensive database that would link our clinical trial and local electronic medical record system data with data from Medicare claims, Medicaid claims, and the Minimum Data Set. The long-range future goal of our research is to help design the next generation of care management interventions for older adults with Alzheimer's disease. The current project will allow us to identify targets for quality improvement and cost savings. This progression from descriptive epidemiologic to intervention studies is a hallmark of our past research. The specific aims of this project are to: 1) build a comprehensive longitudinal dataset across the continuum of care (home, ambulatory, inpatient, nursing home) for a large sample of vulnerable elders; 2) describe and compare the frequency and timing of transitions in care among older adults with dementia, cognitive impairment-no dementia, or normal; 3) describe and compare the costs of care across the continuum of care among older adults with dementia, cognitive impairment-no dementia, or normal; and 4) compare the findings from this cohort of urban poor older adults with findings from the nationally representative Health and Retirement Study (HRS). PUBLIC HEALTH RELEVANCE: Over 4.5 million Americans suffer from Alzheimer's disease. Federal, state, and personal finances are already strained to provide care for the current population, yet the number of older adults with Alzheimer's disease is expected to triple by 2050. Our research seeks to describe the costs and outcomes of care across the full continuum of health care for older adults with dementia. This descriptive data will help inform new treatment models.