Effect of Dementia Caregiver Interventions on Healthcare Cost

描述（由申请人提供）：虽然对痴呆症照顾者的行为干预已被证明可以减轻照顾者的压力和负担，但对其对患者或照顾者的医疗费用的影响的研究很少。缺乏关于干预措施对医疗保健费用影响的信息，特别是对痴呆症患者的影响，可能阻碍了成功干预措施的广泛采用。本研究解决了我们对护理人员成功的行为干预是否对患者和护理人员的实际医疗成本产生影响以及这些影响是否根据护理人员和患者的特征而变化的理解中的重要知识空白。我们的主要研究目标是进行成本识别分析，以确定护理人员参与成功的行为干预，以改善他们自己的应对和患者管理，是否可以节省痴呆症患者的医疗成本。我们还将研究参与干预是否会导致护理人员的医疗保健使用和成本节约。我们建议整合患者和护理人员的数据，这些数据来自于之前两项关于痴呆护理人员成功行为干预的研究，以及医疗保险和退伍军人医疗保健的使用和成本数据。第一项研究是国家随机对照试验资源提高阿尔茨海默氏症照顾者健康（REACH II），从2000年到2003年进行，来自5个地点的642对照顾者。第二项研究是将REACH II纳入退伍军人事务部医疗保健系统（REACH VA）的国家临床翻译，研究对象是来自29个地点的127对患者，时间为2007-2009年。对于REACH II的数据，一半的护理人员接受了旨在帮助他们自己应对和管理患者痴呆症相关行为的行为干预；另一半则接受常规护理。对于每位患者，我们将检查干预前一年、干预期间和干预后一年的医疗保健使用（例如，医生就诊）及其相关费用。将比较护理人员接受干预与未接受干预的患者以及接受干预与未接受干预的患者的使用和成本。在REACH VA研究中，所有护理人员都接受了干预。将比较护理人员接受干预的患者与其他退伍军人事务部痴呆患者的使用和医疗保险费用。对于所有组，我们将确定不同类型的患者和护理人员（例如，不同种族或民族的患者）的使用和成本是否不同。

DESCRIPTION (provided by applicant): Although behavioral interventions for dementia caregivers have been shown to decrease caregiver stress and burden, there has been little examination of their effects on healthcare costs for patients or caregivers. This lack of information on interventions' impact on healthcare costs, particularly for dementia patients, has likely impeded widespread adoption of successful interventions. The proposed study addresses important knowledge gaps in our understanding of whether a successful behavioral intervention for caregivers has an impact on actual healthcare costs for patients and caregivers and whether those impacts vary based on caregiver and patient characteristics. Our main study goal is to conduct a cost identification analysis to determine if there are healthcare cost savings for dementia patients associated with their caregivers' participation in a successful behavioral intervention to improve their own coping and patient management. We will also examine whether participation in the intervention results in healthcare use and cost savings for caregivers. We propose to integrate patient and caregiver data from two previous studies of successful behavioral interventions for dementia caregivers with Medicare and VA healthcare use and cost data. The first study was the national randomized controlled trial Resources for Enhancing Alzheimer's Caregiver Health (REACH II), conducted from 2000 to 2003, with 642 caregiving dyads from 5 sites. The second study was the national clinical translation of REACH II into the Department of Veterans Affairs healthcare system, REACH VA, with 127 dyads from 29 sites, conducted from 2007-2009. For the REACH II data, half the caregivers received the behavioral intervention designed to assist with their own coping and the management of the patient's dementia related behaviors; the other half received usual care. For each patient, we will examine Medicare healthcare use (e.g., physician visits) and their associated costs for one year before the intervention, for the time during the intervention, and for one year after the intervention. Use and costs will be compared for patients whose caregivers received the intervention vs. those who did not and for caregivers who received the intervention vs. those who did not. For the REACH VA study, all caregivers received the intervention. Both VA and Medicare use and costs will be compared for the patients whose caregivers received the intervention vs. a matched comparison group of other VA patients with dementia. For all groups, we will determine if use and costs are different for different types of patients and caregivers (e.g., those of different races or ethnicities).