Relationship of Cognitive Decline with Healthcare Costs and Hospitalization Risk

描述(申请人提供)：疾病和其他痴呆症不仅是老年人口发病率和死亡率的主要原因，而且对医疗保健系统来说也是代价高昂的。了解这些人群对医疗保健的使用对于规划资源投资和发现我们可以改进临床管理的领域都至关重要。我们知识中的一个主要差距是，随着疾病的进展，直接的医疗支出和利用是如何变化的--从临床前阶段开始；因此，目前关于痴呆症相关医疗负担的数据可能低估了真实成本，也可能没有完全解决管理问题。然而，现有的研究依赖于能力有限的数据来检查认知能力下降的所有方面的成本。我们建议通过将达特茅斯公司在基于联邦医疗保险索赔的医疗保健研究方面的专业知识应用于护士健康研究的流行病学资源和专业知识来解决知识和数据差距。护士健康研究是一项持续的队列研究，始于1976年，共有121,700名年龄在30-55岁的女性参加。长期目标是利用护士健康研究(NHS)中关于风险因素和认知测量的丰富纵向数据，通过链接到联邦医疗保险管理数据，对与认知下降相关的医疗支出轨迹进行更大规模的研究。NHS从2000年开始，在6-8年的时间里，每两年对全美近2万名老年女性进行认知电池测试，这可以提供索赔数据中缺乏的认知测量。将这些数据来源联系起来将产生一个强大的研究资源；除了其强大的实力外，NHS还是一个庞大的、地理上多样化的样本，可以按地区和其他变量(如共病)详细检查医疗成本和利用率。NHS的一个局限性是，它包括其专业/教育程度可能导致改变卫生保健服务使用情况的护士，以及不能一概而论的结论。因此，R21旨在：(1)建立NHS和CMS数据库之间的联系；(2)通过与普通医疗保险人群进行比较，解决护士与普通人群不同的利用和支出模式的方法学问题；以及(3)生成关于认知衰退频谱与医疗保健使用和成本之间关系的初始数据(针对这些护士和普通人群之间的任何差异进行校准)。具体地说，在将NHS与联邦医疗保险索赔数据联系起来后，本研究将比较NHS参与者和普通联邦医疗保险人群的使用率，然后开始探索认知下降水平(包括从无下降到认知障碍再到痴呆症的频谱)与成本和使用率的关系。随着对NHS医疗保健利用模式的更多了解，R21将成为达特茅斯和NHS未来合作研究的基础，利用运行时间最长的流行病学研究之一，为健康经济和服务研究的新领域提供信息，以及可能存在的许多其他关于中年风险因素和晚年医疗保健使用的问题。

DESCRIPTION (provided by applicant): Disease and other dementias are not only a major cause of morbidity and mortality in older populations, but also costly to the healthcare system. Understanding the use of healthcare for this population is critically important both for planning resource investments and for discovering areas where we can improve clinical management. One major gap in our knowledge is how direct healthcare spending and utilization change as the disease progresses -- starting at pre-clinical stages; thus current data on dementia-associated healthcare burdens may underestimate true costs and may not fully address management issues. However, existing studies rely on data with limited ability to examine costs across the ful spectrum of cognitive decline. We propose to address the knowledge and data gaps by applying Dartmouth's expertise in Medicare claims- based healthcare research to the epidemiologic resources and expertise of the Nurses' Health Study, an ongoing cohort that began in 1976, with 121,700 women age 30-55 years. The long-term goal is to use the rich longitudinal data on risk factors and cognitive measures in the Nurses' Health Study (NHS) for a larger study of the trajectory of healthcare spending related to cognitive decline by linking to Medicare administrative data. The NHS performed cognitive batteries every 2 years over 6-8 years, starting in 2000, on nearly 20,000 older women across the United States, which can provide the cognitive measures lacking in the claims data. Linking these data sources will yield a powerful resource for research; in addition to its much strength, the NHS is a large and geographically diverse sample, allowing detailed examination of healthcare costs and utilization by region and by other variables, such as co-morbidities. A limitation of the NHS is it includes nurses whose professional/educational attainment could lead to altered use of health care services and non-generalizable conclusions. Thus, this R21 is designed to: (1) establish the linkage between the NHS and CMS databases; (2) address the methodological concern that nurses have different utilization and spending patterns from the general population through comparison with the general Medicare population; and (3) generate initial data regarding the relationship between the spectrum of cognitive decline and healthcare use and costs (calibrated for any differences between these nurses and the general population). Specifically, after linkage of the NHS to Medicare claims data, this study will compare utilization among NHS participants versus the general Medicare population, and then begin to explore how level of cognitive decline (including the spectrum from no decline to cognitive impairment to dementia) relates to costs and utilization. With greater understanding of healthcare utilization patterns in NHS, this R21 will form the basis for future collaborative research between Dartmouth and NHS, leveraging one of the longest running epidemiologic research studies to inform new areas of health economic and services research, and potentially many other questions regarding mid-life risk factors and late life healthcare use.