Factors Associated with Healthcare Utilization Among Community-Dwelling Adults with Clinical Features of Dementia with Lewy Bodies

具有路易体痴呆临床特征的社区居住成年人医疗保健利用的相关因素

基本信息

批准号：
10301251
负责人：
Kathryn A Wyman-Chick
金额：
$ 44.09万
依托单位：
HEALTHPARTNERS INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-30 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10301251
关键词：
Accident and Emergency department Address Adult Adverse reactions Alzheimer&apos s Disease Antipsychotic Agents Autonomic Dysfunction Caregiver Burden Caregivers Caring Clinical Communities Computerized Medical Record Data Data Sources Delirium Dementia Dementia with Lewy Bodies Diagnosis Diagnostic Services Disease Distress Economic Burden Elderly Emergency Situation Emergency department visit Family Goals Health Hospital Costs Hospitalization Hospitals Impaired cognition Incidence Individual Insurance Integrated Delivery of Health Care Intervention Knowledge Length of Stay Lewy Body Dementia Managed Care Medicaid Medical Medical Care Costs Medicare Mental disorders Methods Nursing Homes Older Population Outcome Parkinsonian Disorders Participant Patient Care Patient-Focused Outcomes Patients Pharmaceutical Preparations Physicians Policies Polypharmacy Prevalence Provider Psychoses REM Sleep Behavior Disorder Research Research Personnel Research Proposals Risk Sampling Services Sleep disturbances Symptoms System Vascular Dementia Visit Visual Hallucination adverse outcome associated symptom base burden of illness clinical decision-making comorbidity comparison group cost cost estimate dementia care design detection method early onset experience health care service utilization health data hospital readmission hospitalization rates improved improved outcome indexing medical specialties motor symptom multidisciplinary neuropsychiatric symptom non-demented prevent service utilization

项目摘要

Project Summary The population of older adults and incidence of dementia are expected to increase significantly over the next several decades. Dementia with Lewy bodies (DLB) is the second most common form of dementia following Alzheimer’s disease (AD). DLB is a significant health burden due to high levels of caregiver stress, cognitive decline, psychiatric disorders, autonomic dysfunction, sleep disturbances, and parkinsonism. Dementia is associated with increased utilization of healthcare services compared to non-demented older adults. Individuals with DLB have significantly higher rates of hospitalizations and longer lengths of stay relative to other forms of dementia. Furthermore, patients with DLB tend to have poor outcomes following hospitalization and are more likely to be discharged from the hospital to a higher level of care than patients with AD. The goal of the research proposal is to identify modifiable factors related to increased healthcare utilization, defined as rates of hospitalization, 30-day readmissions, and emergency department visits, in patients with DLB. Ultimately, we aim to identify key factors that could be addressed to prevent distressing and costly hospitalizations and emergency visits for patients with DLB. Delays in dementia diagnosis are also correlated with increased healthcare utilization. DLB is often under recognized. Patients with undiagnosed DLB may be at increased risk of hospitalization due to the use of treatments that are contraindicated in this disorder. For example, patients with DLB often experience psychosis, but they also are more likely to have adverse reactions to antipsychotic medications relative to individuals with other dementia subtypes. Misdiagnosis in DLB is also common and may underestimate the true economic burden of DLB in existing healthcare utilization studies. The current proposal leverages Medicaid, Medicare, and commercial claims data combined with electronic medical records and random chart audits to evaluate rates of healthcare utilization for DLB compared to AD, vascular dementia, unspecified dementia, and healthy controls. To study the impact of potentially undiagnosed DLB on service utilization, this study includes a method of identifying patients with an unspecified dementia diagnosis who have been treated for core and supportive clinical features of DLB. Comorbid medical conditions, polypharmacy, multidisciplinary care, and participation in specialty diagnostic services will be investigated as possible factors related to rates of healthcare utilization among patients with DLB and other forms of dementia. Identifying factors associated with increased healthcare utilization among patients with DLB and dementia patients with clinical features of DLB is critical. Based upon the findings of this study, we will design and implement a targeted intervention within the electronic medical record to help treating providers make clinical decisions to identify undiagnosed cases, improve care, and prevent hospitalizations for patients with DLB.

项目概要预计未来几年老年人口和痴呆症发病率将显着增加几十年来，路易体痴呆（DLB）是继痴呆之后第二常见的痴呆形式。阿尔茨海默病 (AD) 是一种严重的健康负担，因为护理人员的压力、认知能力都很高。衰退、精神疾病、自主神经功能障碍、睡眠障碍和帕金森症。与非痴呆老年人相比，痴呆症与医疗服务利用率增加相关成人 DLB 患者的住院率和住院时间明显更高。此外，与其他形式的痴呆症相比，DLB 患者往往预后较差。住院治疗，并且比患者更有可能出院接受更高级别的护理该研究计划的目标是确定与增加医疗保健相关的可改变因素。利用率，定义为住院率、30 天再入院率和急诊科就诊率，最终，我们的目标是确定可以解决的关键因素，以防止 DLB 患者感到痛苦和痛苦。 DLB 患者的住院和紧急就诊费用昂贵。痴呆症诊断的延迟也与 DLB 医疗利用率的增加相关。未确诊的 DLB 患者可能因使用药物而面临更高的住院风险。例如，DLB 患者经常会经历这种疾病的禁忌治疗。精神病，但相对于其他人，他们也更有可能对抗精神病药物产生不良反应患有其他痴呆亚型的个体 DLB 的误诊也很常见，并且可能低估了 DLB 的误诊率。现有医疗保健利用研究中 DLB 的真实经济负担。当前的提案利用医疗补助、医疗保险和商业索赔数据与电子数据相结合医疗记录和随机图表审核，以评估 DLB 与 AD 相比的医疗保健利用率，血管性痴呆、未明确的痴呆和健康对照研究潜在未确诊的影响。关于服务利用的 DLB，本研究包括一种识别患有未明确痴呆症的患者的方法因 DLB 的核心和支持性临床特征而接受治疗的人。条件、多药治疗、多学科护理以及参与专业诊断服务将研究了与 DLB 和其他患者的医疗保健利用率相关的可能因素痴呆症的形式。确定与 DLB 和痴呆症患者医疗保健利用增加相关的因素具有 DLB 临床特征的患者至关重要。根据本研究的结果，我们将设计和治疗。在电子病历中实施有针对性的干预，以帮助治疗提供者进行临床确定未确诊病例、改善护理并防止 DLB 患者住院的决定。