Home and Community-Based Service Use, Health Outcomes, and Health Care Costs for People with Alzheimer's Disease and Related Dementias

项目摘要 数百万低收入老年人需要长期服务和支持(LTSS)，但 联邦医疗保险和私人保险是有限的，使得医疗补助成为LTSS的主要支付者。为了努力 尊重人们对就地老龄化的偏好并节省成本，州医疗补助计划转向 旨在增加家庭和社区服务(HCBS)使用的政策，作为替代 养老院护理。在这一推动下，阿尔茨海默病和相关痴呆症患者 (ADRD)有越来越多的机会获得医疗补助HCBS。我们建议调查六氯联苯的使用、健康 ADRD患者的结果和医疗费用，特别是那些既有医疗保险又有 医疗补助覆盖范围。 尽管过去几十年来全国范围内六氯苯的使用率有所增加，但不同国家的六氯苯使用率差别很大。 这表明了鼓励使用六氯联苯的国家政策的潜在重要性。例如，州 医疗补助计划对HCBS用户有不同的财务/职能资格和登记上限。然而， 关于国家政策的这些要素如何与六氯联苯的使用相关联，人们知之甚少。作为州医疗补助计划 计划努力增加六氯联苯的使用，需要强有力的证据来证明不同的州医疗补助计划 政策与六氯苯对ADRD患者的使用有关。 尽管州医疗补助计划正在推动HCBS，但这些类型的服务可能并不是对所有人都是最佳的 和ADRD在一起。六氯苯的使用可能会满足人们对就地老龄化的偏好，但随着人们ADRD的进展， 他们可能需要更密集的全天候护理。因此，这些人使用六氯苯可能会导致更低的- 强度超过需要的护理，更糟糕的健康结果，以及更高的医疗费用(由于健康状况更差 结果)。 我们的长期目标是确定州医疗补助HCBS政策中与增加 ADRD患者使用六氯苯，并评估何时适当使用六氯苯以确保他们的安全 社区。这项提议有四个目标。首先，我们描述了六氯联苯的任何使用、健康后果 (住院、急诊科就诊和跌倒)，以及随着时间的推移ADRD患者的医疗费用 (2016-2020)和各州。第二，我们评估州医疗补助HCBS政策与任何 在ADRD患者中使用六氯苯。第三，我们评估使用六氯苯对健康结果的影响。 不同健康水平的ADRD患者。第四，我们评估了六氯苯的使用对健康的影响 不同健康水平的ADRD患者的护理费用。 拟议的研究将提供关于六氯联苯的使用、健康结果和医疗保健的关键信息 ADRD患者的费用。这一知识将有助于告知州医疗补助政策制定者正在寻求 对六氯联苯采取最有效的方法，并最终改善ADRD患者的健康结果。

Project Summary Millions of low-income older adults require long-term services and supports (LTSS) but coverage of LTSS by Medicare and private insurance is limited, leaving Medicaid as the primary payer for LTSS. In an effort to respect people's preference for aging in place and to save costs, state Medicaid programs have turned to policies designed to increase the use of home- and community-based services (HCBS), as an alternative to nursing home care. Under this push towards HCBS, people with Alzheimer's disease and related dementias (ADRD) have increasing opportunities to receive Medicaid HCBS. We propose to investigate HCBS use, health outcomes, and health care costs among people with ADRD, particularly those with both Medicare and Medicaid coverage. Although HCBS use has increased nationwide for the past decades, HCBS use rates vary substantially across states, suggesting the potential importance of state policies to encourage HCBS use. For example, state Medicaid programs have different financial/functional eligibility and enrollment caps for HCBS users. However, little is known about how these elements of state policies are associated with HCBS use. As state Medicaid programs strive to increase HCBS use, there is a need for robust evidence about how different state Medicaid policies are associated with HCBS use for people with ADRD. Despite state Medicaid programs' push towards HCBS, these type of services may not be optimal for all people with ADRD. HCBS use may meet people's preference for aging in place, but as people's ADRD progresses, they may need more intensive round-the-clock care. Therefore, HCBS use for these people may lead to lower- intensity care than needed, worse health outcomes, and higher health care costs (as a result of worse health outcomes). Our long-term goal is to identify elements of state Medicaid HCBS policies associated with an increase in HCBS use by people with ADRD as well as to assess when HCBS is appropriately used to keep them safe in the community. This proposal has four aims. First, we describe any use of HCBS, health outcomes (hospitalization, emergency department visits, and falls), and health care costs for people with ADRD over time (2016-2020) and across states. Second, we assess the association of state Medicaid HCBS policies with any use of HCBS among people with ADRD. Third, we assess the effect of HCBS use on health outcomes for people with ADRD across different levels of health status. Fourth, we assess the effect of HCBS use on health care costs for people with ADRD across different levels of health status. The proposed research will provide critical information about HCBS use, health outcomes, and health care costs for people with ADRD. This knowledge will help inform state Medicaid policymakers who are seeking the most effective approach towards HCBS and ultimately improve health outcomes for people with ADRD.