The impact of Medicare managed care on older patients with dementia and their family caregivers.

摘要 阿尔茨海默病和相关痴呆症(ADRD)在美国的范围是前所未有的， 影响1400万美国人，每年花费2000亿美元。1，2满足ADRD患者的需求 需要大量的长期行为和社会护理支持，这在传统费用下通常是无法提供的- 服务性保险。由于认知能力的限制，老年ADRD患者可能不知道其他 他们有可能受益的保险选择。管理型医疗产品有望 在限制医疗保健使用的同时，改善患者的预后。通过帮助患者，这也可能缓解需求 以获得护理者的支持。因此，管理式护理可能会为ADRD患者及其照顾者提供至关重要的好处。 然而，人们对管理型护理在痴呆症护理中的作用知之甚少。重要的是要了解 患有ADRD的老年人正在使用管理型医疗产品，他们使用的是哪些产品，以及护理者的角色 在这样的决定中。了解管理式医疗对老年人健康结果的影响也很重要 ADRD患者包括使用非正式护理。考虑到痴呆症的负担以及相关的影响 对于照顾者来说，迫切需要进行研究，以解决这些知识差距。使用纵向 医疗保险住院数据，加上全国调查数据，拟议的研究将使用工具变量 分析探讨管理性护理对患有ADRD的老年人的影响，包括接受护理。 创新：该拨款将是第一个严格审查管理型医疗项目对以下方面成果的作用的基金 一种衰弱的疾病，需要老年人及其家庭照顾者的自我管理。要做到这一点，它将 使用独特而强大的调查和索赔数据组合来检查管理型护理和痴呆症的结果。 这些分析将由一个具有临床和研究专长的跨学科研究小组进行 痴呆症护理、护理和结果评估以及政策研究的领导者。最后，我们有 一项强有力的传播战略，利用我们机构资源的优势进行快速传播。 影响：该项目将利用大型国家数据集以及调查和行政管理之间罕见的联系 数据，为临床医生和政策制定者提供见解，以改善ADRD的覆盖和护理战略， 能够支持老年人及其非正式照顾者的可行方法。它将通知保险公司 关于管理性医疗在多大程度上成功地满足了ADRD人口的需求，以及 帮助患者和护理人员了解选择对他们的健康最有益的保险产品。

ABSTRACT The scope of Alzheimer’s disease and related Dementias (ADRD) in the United States is unprecedented, affecting 14 million Americans at an annual cost of $200 billion.1,2 Addressing the needs of patients with ADRD requires substantial long-term behavioral and social care supports not typically available under traditional fee- for-service insurance. Due to their cognitive limitations, older patients with ADRD may not know that other potentially beneficial insurance options are available to them. Managed care products may be expected to improve patient outcomes while restraining health care use. By helping patients, this might also alleviate need for caregiver support. Thus, managed care might offer critical benefits for ADRD patients and their caregivers. However, little is known about the role of managed care in dementia care. It is important to understand whether older individuals with ADRD are using managed care products, which ones they use, and the role of caregivers in such decisions. It is also important to understand the impact of managed care on health outcomes for older patients with ADRD including use of informal care. Given the burdens of dementia, and associated impacts on caregivers, there is a critical need to pursue research to address these knowledge gaps. Using longitudinal Medicare inpatient data, plus national survey data, the proposed research will use instrumental variables analysis to explore the impact of managed care on older adults with ADRD including receipt of caregiving. Innovation: The grant will be the first to rigorously examine the role of managed care programs on outcomes for a debilitating disease requiring self-management from older adults and their family caregivers. To do so, it will use a unique and robust mix of survey and claims data to examine managed care and dementia outcomes. These analyses will be conducted by an interdisciplinary study team with clinical and research expertise in dementia care, caregiving, and outcomes measurement as well as leaders in policy research. Finally, we have a robust dissemination strategy exploiting the strengths of our institutional resources for rapid dissemination. Impact: This project will leverage large national datasets and rare linkages between survey and administrative data to provide insights for clinicians and policymakers into improving coverage and care strategies for ADRD, and actionable methods that can support older individuals and their informal caregivers. It will inform insurers about the extent to which managed care is successful in addressing the needs of the ADRD population and help patients and caregivers learn select insurance products that are most beneficial for their health.