Personality and Health Services Use and Expenditures of Older Persons

描述（由申请人提供）：在美国，包括老年人在内的人均医疗保健支出极高，这是一个主要的临床、公共卫生和公共政策问题。美国医疗保健效率低下与自由裁量服务的广泛过度使用以及有效的非自由裁量服务的大量使用不足直接相关。如果人格与晚年的医疗保健使用和支出有关，那么它可能是制定有针对性和量身定制的干预措施以解决过度和不足使用问题的关键因素。然而，目前尚不清楚性格是否与医疗支出有关。这项研究将确定这种关系是否存在。如果存在这种关系，这项重新提交的R03次要分析的长期目标将是一个研究项目，以开发利用人格域来解决医疗保险受益人过度使用和使用不足的干预措施。大量文献表明，健康状况、信念、态度、行为和医疗保健决策都与人格有关。人们普遍认为，人类性格的主要维度可以分为五大领域，即“五大”：神经质、外向性、开放性、宜人性和尽责性。将使用NEO-Five Factor Inventory （NEO-FFI）对五大因素进行评估。虽然有9项研究发现了人格领域与卫生服务使用之间的关联，但只有一项研究专门针对65岁及以上的人，9项研究中有5项关注心理卫生服务。具体目的是确定人格域与以下因素之间是否存在关联：(1)医疗保险、非医疗保险和医疗保健总支出，(2)最昂贵的急性和长期护理服务（急性住院天数、急诊科就诊、疗养院天数和监护家庭护理时间），以及(3)自主医疗服务的高低。数据来自1308名社区医疗保险受益人，他们参加了医疗保险初级和消费者导向的医疗示范。该研究的很大一部分意义来自于样本，样本由很少参与深入研究的群体（社会经济地位较低/受教育程度较低）组成。结果变量是根据通过每日卫生保健期刊收集的30种医疗保健服务的使用数据计算的支出（目标1），从这些每日期刊获得的使用类别（目标2），以及医疗保险和医疗补助服务中心提供的医疗保险索赔数据（目标3）。利用将估计负二项，两部分，和/或障碍回归模型。支出将采用两部分广义线性模型。标准误差和95%置信区间将使用聚类非参数bootstrap方法进行估计。建立个性与医疗保健使用或支出之间的联系将导致开展旨在建立因果机制的研究，并最终针对过度使用可自由支配服务或有效非自由支配服务使用不足的个人的特点采取干预措施。

DESCRIPTION (provided by applicant): The presence of extremely high healthcare expenditures per capita, including for elderly persons, is a major clinical, public health, and public policy problem in the U.S. The lack of efficiency in U.S. healthcare is directly related to extensive overuse of discretionary services as well as to substantial underuse of effective non-discretionary services. If personality is associated with healthcare use and expenditures in later life, then it could be a critical factor in the development of targeted and tailored interventions to address over- and underuse. However, it is not known whether personality is associated with healthcare expenditures. This study will establish whether this relationship exists. If the relationship exists, the long-term objective of this resubmitted R03 secondary analysis will be a program of research to develop interventions that take advantage of personality domains to address overuse and underuse among Medicare beneficiaries. An extensive literature shows that health status, beliefs, attitudes, and behaviors and healthcare decision-making are all related to personality. There is strong consensus that the major dimensions of human personality can be grouped into 5 broad domains known as the "Big Five": Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness. The Big Five will be assessed using the NEO-Five Factor Inventory (NEO-FFI). While 9 studies have found an association between personality domains and health services use, only one included exclusively persons age 65 and older, and 5 of the 9 focused on mental health services. The Specific Aims are to establish if associations exist between personality domains and (1) Medicare, non-Medicare, and total healthcare expenditures, (2) 4 of the most expensive acute and long term care services (acute hospital days, emergency department visits, nursing home days, and custodial home care hours), and (3) high versus low discretionary healthcare services. The data were collected from 1308 community-dwelling Medicare beneficiaries participating in the Medicare Primary and Consumer-Directed Care Demonstration. A large part of the study's significance derives from the sample, which is made up of groups (lower SES/education) that rarely participate in intensive research. Outcome variables are expenditures calculated from utilization data collected via daily Health Care Journals for 30 healthcare services (Aim 1), categories of utilization obtained from these daily Journals (Aim 2), and Medicare claims data provided by the Centers for Medicare and Medicaid Services (Aim 3). Utilization will be estimated by negative binomial, two- part, and/or hurdle regression models. Two-part generalized linear models will be employed for expenditures. Standard errors and 95% confidence intervals will be estimated using clustered non-parametric bootstrap methods. The establishment of associations between personality and healthcare use or expenditures will lead to studies designed to establish causal mechanisms and ultimately to interventions that are targeted or tailored to characteristics of individuals that overuse discretionary or underuse effective non-discretionary services. PUBLIC HEALTH RELEVANCE: The proposed study is highly relevant to public health because overuse of some discretionary healthcare services and underuse of effective, readily available, non-discretionary services represent major public policy problems and potential threats to public health, especially for Medicare beneficiaries. The public health and policy implications of the relationship between personality and healthcare use and expenditures in later life have rarely, if ever, been considered. If we are able to show associations between personality domains and healthcare use and expenditures, we anticipate convening a conference to explore the clinical, public health, and policy implications of the role of personality for healthcare services utilization and expenditures in order to be able to develop clinical trials to investigate targeted and tailored interventions and community-based translational effectiveness studies to reduce overuse of discretionary healthcare services and increase underuse of effective non-discretionary services.