Health Care Expenditures for Nursing Home Residents with Advanced Dementia

描述（由申请人提供）：患有晚期痴呆症的养老院居民通常在生命末期接受积极的护理，这可能是一种负担，而且临床效益值得怀疑。然而，与照顾这些居民有关的支出从未被描述过，影响这些支出的因素也不得而知。晚期痴呆症临终关怀的选择、态度和策略（CASCADE）研究是美国国立卫生研究院资助的一项前瞻性队列研究，于2003-2009年间进行。CASCADE研究产生了一个非常丰富的数据集，严格详细描述了一组明确定义的NH晚期痴呆症患者的病程及其家庭成员的经历，随访时间长达18个月。在这个R21应用程序中，我们建议利用独特的CASCADE数据集，将其与医疗保险和医疗补助索赔文件联系起来，以描述和检查与老年痴呆症患者护理支出相关的因素。这将是首次对这一人群的医疗保健支出进行研究。提出了以下具体目标：目标1。描述2003年至2009年间居住在波士顿地区22家机构的317名晚期痴呆症NH居民的医疗保险和医疗补助支出。分析将确定支出变化的来源，并检查与这些居民较高支出相关的因素。目标2。描述CASCADE队列中258例晚期痴呆患者在死亡前（0-3个月、3-6个月、6-9个月、9-12个月）的医疗保险和医疗补助支出。影响：将医疗保险和医疗补助索赔与已建立的临床丰富数据集联系起来，该数据集严格定义了317名患有晚期痴呆症的NH居民，为描述治疗这种疾病的支出和检查与这些支出相关的因素提供了独特的机会。此外，这项探索性工作将为NIH R01拨款申请提供初步数据和基础，该申请旨在使用相关的国家数据集，在更大范围内研究晚期痴呆症的医疗保健支出。总之，拟议的工作代表了规划服务和政策的第一步，这些服务和政策促进了高质量、符合患者偏好和具有成本效益的晚期痴呆症临终关怀。

DESCRIPTION (provided by applicant): Nursing home residents with advanced dementia commonly receive aggressive care near the end-of-life that can be burdensome and of questionable clinical benefit. However, the expenditures associated with caring for these residents have never been described and the factors influencing those expenditures are not known. The Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life (CASCADE) study was an NIH-funded prospective cohort study conducted between 2003-2009. The CASCADE study yielded a very rich dataset rigorously detailing the course of a well-defined cohort of NH residents with advanced dementia and the experience of their family members followed for up to 18 months. In this R21 application, we propose to leverage the unique CASCADE dataset by linking it to Medicare and Medicaid claims files in order to describe and examine factors associated with the expenditures on care for NH residents with advanced dementia. This will be the first study of health care expenditures in this population. The following specific aims are proposed: Aim 1. To describe the Medicare and Medicaid expenditures on care for 317 NH residents with advanced dementia living in 22 Boston area facilities between 2003 and 2009. The analyses will identify the sources of spending variation, and examine factors associated with higher expenditures in these residents. Aim 2. To describe the Medicare and Medicaid expenditures on care for 258 decedents with advanced dementia from the CASCADE cohort across intervals prior to death (0-3 months, 3-6 months, 6-9 months, 9-12 months). Impact: Linking Medicare and Medicaid claims to an established, clinically rich dataset of a rigorously defined cohort of 317 NH residents with advanced dementia provides a unique opportunity to describe expenditures for treating this condition and examine factors associated with these expenditures. In addition, this exploratory work will provide preliminary data and the foundation for an NIH R01 grant application that will aim to use linked national datasets to study health care spending on advanced dementia on a larger scale. Taken together, the proposed work represents the first step towards planning services and policies that promote end-of-life care in advanced dementia that is of high quality, consistent with patient preferences, and cost-effective. PUBLIC HEALTH RELEVANCE: There has been much interest among policymakers in the costs of caring for nursing home patients with advanced dementia. By linking administrative claims data with unique clinical information collected from advanced dementia patients and their families, this study provides an opportunity to improve the efficiency of care for the millions of Americans that receive dementia care in the nursing home setting.