Microsimulation Modeling to Compare the Effectiveness and Cost-Effectiveness of Nondrug Interventions to Manage Clinical Symptoms in Racially/Ethnically Diverse Persons with Dementia

微观模拟模型比较非药物干预措施管理不同种族/民族痴呆症患者临床症状的有效性和成本效益

• 批准号: 10417166
• 负责人: Eric Jutkowitz
• 金额: $ 39.83万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10417166
• 关键词: Address; Adoption; Adult; Adverse event; Affect; African American; African American population; Alzheimer' s Disease; American; Antipsychotic Agents; Asian; Behavior; Behavioral Symptoms; Biological Models; Caregivers; Caring; Child; Clinical; Clinical Management; Cognition; Communities; Data; Dementia; Disease; Economics; Effectiveness; Effectiveness of Interventions; Ethnic Origin; Evaluation; Expenditure; Exposure to; Family; Family Caregiver; Family Policy; Goals; Health; Health and Retirement Study; Healthcare; Hispanic; Home; Hour; Impaired cognition; Incidence; Individual; Intervention; Lifestyle-related condition; Medicare; Medicare/Medicaid; Methods; Minority Groups; Modeling; Nursing Homes; Outcome; Paper; Persons; Pharmaceutical Preparations; Policies; Population; Program Effectiveness; Provider; Publications; Publishing; Quality of life; Quality-Adjusted Life Years; Race; Randomized Controlled Trials; Reporting; Research; Science; Societies; Spouses; Symptoms; Testing; Time; care systems; caregiving; community based care; comparative effectiveness; compare effectiveness; cost; cost effectiveness; effectiveness trial; ethnic difference; ethnic diversity; evidence base; family structure; fictional works; functional decline; health disparity; implementation cost; inclusion criteria; informal caregiver; innovation; life time cost; models and simulation; non-drug; pragmatic trial; programs; racial and ethnic; randomized trial; response; simulation; skills; symposium; systematic review

Project Summary Alzheimer’s Disease and Related Disorders (ADRD) affects >5 million Americans, disproportionately impacts minority populations, and has significant economic consequences. Two clinical features in particular: functional decline and behavioral symptoms, are associated with more caregiving and Medicare/Medicaid/family expenditures when compared to cognitive decline alone. To help individuals with ADRD remain at home with quality of life, it is vital to provide family caregivers, the largest providers of ADRD care, with effective support. Unlike drugs (e.g., antipsychotics), nondrug ADRD interventions are not associated with adverse events and are recommended as first-line treatments. Systematic reviews conclude that nondrug dyadic interventions that engage the person with ADRD and provide caregivers skills effectively maintain or slow functional decline and/or reduce ADRD-related behaviors. It is unclear as to the effects of these proven programs on outcomes of relevance to families and policymakers (e.g., time spent caregiving) throughout the disease trajectory and whether effects differ by race/ethnicity. Racial/ethnic differences in the use of nursing homes, ability to pay for health care, and family structures may impact population effectiveness of interventions. In response to PAR- 18-331, we propose to use innovative methods in simulation modeling to extend findings from completed randomized controlled trials (RCTs) on select dyadic interventions. Specifically, we will use our published ADRD microsimulation model (ADRD-MM) to infer the effect of proven dyadic interventions on outcomes of hours caregiving, days in a nursing home, costs, and the person with ADRD’s and their caregiver’s quality- adjusted life-years. We will also evaluate outcomes by race/ethnicity. Our simulation model used data from the National Alzheimer’s Coordinating Center, the Health and Retirement Study, and Medicare to simulate an incident ADRD case’s decline in function, behavior, and cognition and associated family and policy outcomes. For our proposed study, we have identified eight proven dyadic interventions that meet our inclusion criteria of 1) being tested in RCTs in US community-dwelling persons with ADRD and/or their caregivers and 2) having outcome publications that provided effect sizes and sufficient data to estimate implementation cost. Using the ADRD-MM, our specific aims are to: 1) Determine the effects by race (African American, Asian, and White) and ethnicity (Hispanic) of identified nondrug ADRD dyadic interventions on family hours caregiving, days in a nursing home, costs to families/Medicaid/Medicare, and quality-adjusted life-years of the person with ADRD and their caregivers; 2) compare effectiveness, cost-effectiveness, and affordability by race (African American, Asian, and White) and ethnicity (Hispanic) of the identified ADRD interventions; and 3) determine which of the identified ADRD interventions should be tested in additional trials by race (African American, Asian, and White) and ethnicity (Hispanic) to inform nondrug ADRD research prioritization. Our study will yield new data on the impact of nondrug ADRD interventions on societal outcomes and extend the evidence-base of RCTs.

项目概要 阿尔茨海默病及相关疾病 (ADRD) 影响超过 500 万美国人，影响程度不成比例 少数民族人口，并具有显着的经济后果，特别是两个临床特征：功能。 衰退和行为症状，与更多的护理和医疗保险/医疗补助/家庭有关 与单独认知能力下降相比，帮助 ADRD 患者留在家中的支出。 为了提高生活质量，为家庭护理人员（ADRD 护理的最大提供者）提供有效的支持至关重要。 与药物（例如抗精神病药）不同，非药物 ADRD 干预与不良事件无关，并且 系统评价的结论是，非药物二元干预措施被推荐作为一线治疗。 让 ADRD 患者参与并为护理人员提供有效维持或减缓功能衰退的技能 和/或减少 ADRD 相关行为目前尚不清楚这些经过验证的计划对结果的影响。 在整个疾病轨迹中与家庭和政策制定者的相关性（例如，花在护理上的时间）以及 种族/民族对疗养院使用、支付能力的影响是否存在差异。 医疗保健和家庭结构可能会影响针对 PAR- 的干预措施的人群有效性。 18-331，我们建议在模拟建模中使用创新方法来扩展已完成的研究结果 具体来说，我们将使用我们已发表的针对选定二元干预措施的随机对照试验（RCT）。 ADRD 微观模拟模型 (ADRD-MM)，用于推断经过验证的二元干预措施对结果的影响 护理时间、在疗养院的天数、费用以及 ADRD 患者及其护理人员的质量 - 我们还将根据种族/民族来评估结果。 国家阿尔茨海默病协调中心、健康与退休研究和医疗保险模拟 事件 ADRD 病例的功能、行为和认知能力下降以及相关的家庭和政策结果。 对于我们提出的研究，我们确定了八种经过验证的二元干预措施，它们符合我们的纳入标准： 1) 在美国社区居住的 ADRD 患者和/或其护理人员中接受随机对照试验测试，并且 2) 结果出版物提供了效果大小和足够的数据来估计实施成本。 ADRD-MM，我们的具体目标是：1）确定种族的影响（非裔美国人、亚洲人和白人） 和种族（西班牙裔）已确定的非药物 ADRD 二元干预措施对家庭护理时间、在家中的天数的影响 疗养院、家庭/医疗补助/医疗保险费用以及 ADRD 患者的质量调整生命年 及其照顾者；2) 按种族比较有效性、成本效益和负担能力（非裔美国人、 已确定的 ADRD 干预措施的种族（西班牙裔）和种族（西班牙裔）；以及 3) 确定哪些干预措施； 确定的 ADRD 干预措施应在额外的试验中按种族（非裔美国人、亚洲人和白人）进行测试 和种族（西班牙裔）来确定非药物 ADRD 研究的优先顺序。我们的研究将产生有关 ADRD 的新数据。 非药物 ADRD 干预措施对社会结果的影响并扩展随机对照试验的证据基础。

项目成果

Statistical harmonization of everyday functioning and dementia-related behavioral measures across nine surveys and trials.

九项调查和试验中日常功能和痴呆相关行为测量的统计协调。

• 发表时间: 2023
• 作者: Chen, Diefei;Jutkowitz, Eric;Gross, Alden L
• 通讯作者: Gross, Alden L

Screening Strategies to Reduce COVID-19 Mortality in Nursing Homes.

降低疗养院 COVID-19 死亡率的筛查策略。

• 发表时间: 2024-04-05
• 作者: Dong, Shirley;Jutkowitz, Eric;Giardina, John;Bilinski, Alyssa
• 通讯作者: Bilinski, Alyssa

Association of statewide stay-at-home orders with utilization of case management and supportive services for veterans experiencing housing insecurity.

全州范围内的居家令与利用案件管理和为经历住房不安全的退伍军人提供支持服务的协会。

• 发表时间: 2022
• 作者: Jutkowitz, Eric;Halladay, Christopher;Tsai, Jack;Hooshyar, Dina;Cornell, Portia Y;Rudolph, James L
• 通讯作者: Rudolph, James L

Risk of dementia among veterans experiencing homelessness and housing instability.

无家可归和住房不稳定的退伍军人面临痴呆风险。

• 发表时间: 2024-02
• 影响因子: 6.3
• 作者: Roncarati, Jill S;DeVone, Frank;Halladay, Christopher;Tsai, Jack;Jutkowitz, Eric
• 通讯作者: Jutkowitz, Eric

Incidence of Homelessness among Veterans Newly Diagnosed with Alzheimer's Disease and Related Dementias.

新诊断患有阿尔茨海默病和相关痴呆症的退伍军人中无家可归的发生率。

• 发表时间: 2021-05-03
• 作者: Jutkowitz, Eric;DeVone, Frank;Halladay, Christopher;Hooshyar, Dina;Tsai, Jack;Rudolph, James L
• 通讯作者: Rudolph, James L