Effect of Medicare Reimbursement for Care Planning on End of Life Care among Patients with Alzheimer's Disease and Related Dementias: A Quasi-Experimental Study

医疗保险报销护理计划对阿尔茨海默病和相关痴呆症患者临终护理的影响：一项准实验研究

• 批准号: 10172824
• 负责人: Jing Li
• 金额: $ 12.58万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10172824
• 关键词: Address; Admission activity; Advance Care Planning; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease related dementia; American; Atlases; Caring; Cause of Death; Cessation of life; Characteristics; Code; Communication; Community Surveys; Comprehensive Health Care; Data; Data Sources; Development; Elderly; Enrollment; Enteral Feeding; Evaluation; Event; Funding; Geriatrics; Goals; Health; Health Personnel; Health Policy; Healthcare; Hospice Care; Hospitalization; Hospitals; Impaired cognition; Individual; Intensive Care Units; Lead; Life; Logistic Regressions; Measures; Medicare; Medicare claim; Neighborhoods; Nursing Homes; Palliative Care; Patient Preferences; Patients; Physicians; Policies; Probability; Procedures; Process; Provider; Quality Indicator; Quality of Care; Quality of life; Quasi-experiment; Research; Research Design; Research Methodology; Research Personnel; Residencies; Services; Techniques; Training; aggressive therapy; aging population; career; cognitive testing; comorbidity; cost; decision-making capacity; dementia care; demographics; design; end of life; end of life care; experience; hospice environment; improved; innovation; instrument; medical specialties; socioeconomics; statistical learning

PROJECT SUMMARY Alzheimer's disease and Alzheimer's Disease-related dementias (AD/ADRD) are a leading cause of death in the U.S. More than 40% of all Medicare patients who die in a given year have AD/ADRD, and the number of deaths from AD/ADRD are fast growing. Dying individuals with AD/ADRD use more aggressive care at end of life, including burdensome transitions to the hospital and invasive procedures of questionable benefit, compared to those with no cognitive impairment. Advance care planning (ACP), the process of discussing and recording patient preferences for goals of care in the event of patient losing capacity, has been shown to decrease aggressive treatment and increase use of hospice and palliative care, in particular among AD/ADRD patients. Barriers to ACP exist, and no research has examined the causal effect of ACP on end-of-life (EOL) care among AD/ADRD patients using national data. This proposal addresses these gaps by examining two recent changes in Medicare reimbursement policy: the introduction of ACP billing codes on January 1, 2016, and the introduction of comprehensive care planning (CCP) billing codes on January 1, 2017. The CCP targets cognitively impaired patients and consists of several mandated components, including development, revision or review of an Advance Care Plan. No direct evidence exists on the effect of these two reimbursement changes on EOL care; in general or among AD/ADRD patients. This proposal will utilize Medicare claims data merged with several supplementary data sources to examine multiple physician and patient factors associated with ACP and CCP billing, and will innovatively apply two quasi-experimental study designs to separately examine the causal effect of ACP and CCP billing on EOL care spending and multiple measures of EOL care utilization commonly used as indicators for quality of EOL care, among AD/ADRD patients nationwide. Advanced statistical learning techniques will be employed to further correct bias and improve precision of causal estimates. The Specific Aims are: (1) To identify the physician and patient characteristics associated with ACP and CCP billing for AD/ADRD patients; (2) To determine the effect of ACP billing on EOL care utilization and spending among AD/ADRD patients using a Regression Discontinuity Design (RDD); (3) To determine the effect of CCP billing on EOL care utilization and spending among AD/ADRD patients using an Instrumental Variables (IV) approach. IMPACT: This project will provide rigorous and critical evidence to directly inform effective policies targeted at improving EOL care for AD/ADRD patients. Further, this K01 application will establish the applicant as one the few health economists with expertise in AD/ADRD, geriatrics and palliative care. It will prepare her to become an R01-funded independent investigator in policy evaluations that lead to improved quality of care and quality of life for the aging population, in particular AD/ADRD patients.

项目摘要 阿尔茨海默氏病和阿尔茨海默氏病与疾病相关的痴呆症（AD/ADRD）是主要原因 在美国死亡中，在给定年份死亡的所有医疗保险患者中，有40％的死亡患有广告/adrd， AD/ADRD的死亡人数快速增长。患有广告/ADRD的人使用更多积极的护理 在生命的尽头，包括繁重的过渡到医院的过渡和可疑利益的侵入性程序， 与没有认知障碍的人相比。预先护理计划（ACP），讨论和 在患者失去容量时，记录患者偏好的护理目标，已被证明 减少积极的治疗并增加临终关怀和姑息治疗的使用，特别是在AD/ADRD中 患者。存在ACP的障碍，并且没有研究检查ACP对生命终止（EOL）的因果影响 使用国家数据的AD/ADRD患者护理。该建议通过检查两个来解决这些差距 Medicare报销政策的最新变化：2016年1月1日引入ACP计费代码， 并于2017年1月1日引入综合护理计划（CCP）计费代码。 认知受损的患者，由几个强制性组件组成，包括开发，修订 或审查预先护理计划。关于这两种报销的影响，没有直接的证据 EOL护理的变化；通常或在AD/ADRD患者中。该建议将利用Medicare索赔数据 与几个补充数据源合并，以检查多个医师和患者因素 使用ACP和CCP计费，并将创新使用两种准实验研究设计 检查ACP和CCP计费对EOL护理支出的因果影响和EOL护理的多种指标 在全国广告/ADRD患者中，通常用作EOL护理质量的指标。 先进的统计学习技术将采用进一步纠正偏见并提高精度 因果估计。具体目的是：（1）确定与医师和患者特征相关的 用于AD/ADRD患者的ACP和CCP计费； （2）确定ACP计费对EOL护理的影响 使用回归不连续设计（RDD）在AD/ADRD患者中的利用和支出； （3）到 使用A AD/ADRD患者在AD/ADRD患者中确定CCP计费对EOL护理利用和支出的影响 仪器变量（IV）方法。影响：该项目将为严格而关键的证据提供 直接告知针对改善AD/ADRD患者EOL护理的有效政策。此外，这个K01 申请将把申请人确立为少数在AD/ADRD，老年医学方面具有专业知识的卫生经济学家的一员 和姑息治疗。这将使她成为政策评估中的R01资助的独立调查员 这会改善人口老龄化的护理质量和生活质量，尤其是AD/ADRD患者。