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

• 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
• 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' 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

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.

项目摘要 老年人的人口和痴呆症的发生率预计将在下一个 几十年。 Lewy身体（DLB）的痴呆症是第二大最常见的痴呆形式。 阿尔茨海默氏病（AD）。 DLB由于高水平的护理人员压力，认知能力而遭受重大健康燃烧 衰落，精神疾病，自主神经功能障碍，睡眠障碍和帕金森主义。 痴呆与医疗服务的利用增加有关 成年人。 DLB患者的住院率明显更高，住院时间更长 相对于其他形式的痴呆症。此外，DLB患者的预后往往很差 与患者相比，住院和更有可能从医院出院到更高的护理水平 与广告。研究建议的目的是确定与医疗保健增加有关的可修改因素 利用率，定义为住院率，30天的再入院和急诊室就诊， DLB患者。最终，我们旨在确定可以解决的关键因素，以防止痛苦和 DLB患者的昂贵住院和紧急就诊。 痴呆诊断的延迟也与增加的医疗保健利用率相关。 DLB经常在下面 认可。由于使用未诊断DLB的患者可能会增加住院的风险 在这种疾病中禁忌的治疗方法。例如，DLB患者经常经历 精神病，但它们也更有可能对抗精神病药物产生不良反应 具有其他痴呆症亚型的个体。 DLB中的误诊也很常见，可能会低估 DLB的真正经济伯恩在现有的医疗保健利用研究中。 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结合 与AD相比，医疗记录和随机图表审核以评估DLB的医疗保健利用率 血管性痴呆，未指定的痴呆和健康对照。研究潜在未诊断的影响 DLB服务利用，本研究包括一种识别未指定痴呆症患者的方法 接受过核心和DLB临床特征的诊断。合并医学 条件，多药，多学科护理以及专业诊断服务的参与将是 调查了与DLB和其他患者中医疗保健利用率相关的可能因素 痴呆形式。 识别DLB和痴呆症患者的医疗保健利用率增加相关的因素 DLB临床特征的患者至关重要。根据这项研究的发现，我们将设计和 在电子病历中实施有针对性的干预措施，以帮助治疗提供者进行临床 确定未诊断病例，改善护理并防止DLB患者住院的决定。