A National Analysis of Observation Care Among Medicare Beneficiaries with Alzheimer's Disease and Related Dementias

急诊科就诊在美国很常见，约五分之一 美国人每年至少去一次急诊室。老年人，特别是那些有 阿尔茨海默病和相关痴呆症(ADRD)，使用ED的比率较高，并有 甚至更大的不良后果风险。急症室的挤迫情况可能会构成特别的安全风险 对于那些认知受损的人。观察单元护理已被提出作为解决 紧急护理的时间紧迫性。事实上，最近几年出现了显著的增长 对向急诊室提出的老年人使用观察护理多年。然而，人们对此感到担忧 这种观察停留可能不适合某些患者，并可能与 与传统的住院治疗相比，结果更差。有证据表明，观察到 当护理仅限于针对特定情况的程序化护理时，护理会产生最佳结果。然而， 大多数观察护理不是在这种结构化的环境中提供的。因此，理想的模型是 观察护理可能不是主要的护理，特别是对于患有 阿尔茨海默病和相关痴呆症(ADRD)，他们更多地向ED提出 定义不明确的非特定症状和情况。然而，关于现代社会的证据 成人ADRD的观察护理缺乏景观。我们将使用国家医疗保险 声称要检查医疗保险观察护理的使用率和强度的趋势 ADRD受益人。我们将使用一种新的方法来评估在一定程度上 医院一直在用观察期代替住院护理、直接急诊出院或 两者都有。此外，我们将描述与以下因素相关的临床结果的趋势 对ADRD受益人的观察护理。我们将使用联邦医疗保险索赔来识别 与这些结果相关的患者、医院和区域水平的变量。我们会 使用国家医疗保险索赔分析的结果来开发一种风险预测工具 一线临床医生对患有ADRD的受益人进行风险分层，以了解与以下疾病相关的不良后果 观察护理。这项全国性的纵向研究将使一线临床医生能够更好地定制 运用观察护理来满足ADRD患者的需求。

Emergency department (ED) visits are common in the United States, with approximately 1 in 5 Americans visiting the ED at least once per year. Older adults, particularly those with Alzheimer’s Disease and Related Dementias (ADRD), use the ED at higher rates and have an even greater risk of adverse outcomes. Crowded ED conditions may pose particular safety risks for those with impaired cognition. Observation unit care has been proposed as a solution to the time-pressured nature of emergency care. Indeed, there has been a marked growth in recent years in the use of observation care for older adults presenting to the ED. Yet, there is concern that observation stays may be inappropriate for some patients and may be associated with poorer outcomes compared to a traditional inpatient stay. Evidence suggests that observation care yields the best outcomes when limited to protocolized care for specific conditions. Yet, the majority of observation care is not provided in such structured settings. Thus, the ideal model of observation care is likely not the predominant one, particularly for the population of patients with Alzheimer’s disease and related dementias (ADRD), who more often present to the ED with nonspecific symptoms and conditions that are less well-defined. Yet, evidence on the modern landscape of observation care for adults with ADRD is lacking. We will use national Medicare claims to examine trends in the utilization and intensity of observation care for Medicare beneficiaries with ADRD. We will use a novel approach to evaluate the degree to which certain hospitals have been substituting observation stays for inpatient care, direct ED discharge or both. Furthermore, we will characterize the trends in clinical outcomes associated with observation care for beneficiaries with ADRD. We will use Medicare claims to identify the patient, hospital and regional-level variables that are associated with these outcomes. We will use the findings from analyses of national Medicare claims to develop a risk-prediction tool for frontline clinicians to risk-stratify beneficiaries with ADRD for adverse outcomes associated with observation care. This national, longitudinal study will enable frontline clinicians to better tailor the use of observation care to the needs of patients with ADRD.