Alzheimer's Disease and Related Dementia Care within the Medicare Program

医疗保险计划内的阿尔茨海默病和相关痴呆症护理

基本信息

批准号：
10221576
负责人：
JOHN HSU
金额：
$ 70.39万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-30 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10221576
关键词：
Address Affect Alzheimer&apos s disease related dementia American Antipsychotic Agents Area Attention Benchmarking Caring Cholinesterase Inhibitors Chronic Clinical Clinical Research Code Combined Modality Therapy County Data Data Science Data Set Dementia Diabetes Mellitus Diagnosis Diagnostic Disease Dose Electronic Health Record Enrollment Epilepsy Evaluation Family Fee-for-Service Plans Future Geography Gold Guideline Adherence Guidelines Health Services Accessibility Health system Hypothyroidism Incentives Individual Intervention Life Link Malignant Neoplasms Measures Medical Medicare Medicare claim Modernization Morbidity - disease rate Natural experiment Neurologist Pathway interactions Patient Care Patients Patterns of Care Penetration Physicians Policies Policy Maker Policy Research Population Privatization Process Registries Research Risk Structure Subgroup Testing Therapeutic United States Validation Work apolipoprotein E-4 base beneficiary cost data registry dementia care dual eligible ethnic minority population evidence based guidelines family burden flexibility genetic testing improved insurance plan medical specialties novel patient population payment programs racial and ethnic

项目摘要

Abstract: Millions of Americans have Alzheimer's Disease and Related Dementias (“dementia”), with many millions more expected to develop it over the next few decades; dementia is a life-altering condition with high levels of associated morbidity. Most of these patients are Medicare beneficiaries. With new treatments on the horizon, there is both a promise for future improvements and risk because of the potential cost of such treatments combined with growing numbers of patients, especially risk of fiscal strain for patients, families, and the Medicare program (total spending is estimated to reach $1 trillion dollars/year by 2050). Despite the promise and risk, there is limited information about current dementia care within the traditional fee-for-service Medicare program (aka TM), the larger of Medicare's two components (the other component is Medicare Advantage (MA), which is administered by private plans). One major barrier to examining care nationally within the Medicare program is the uncertain validity of dementia diagnoses in claims data. To address these issues, we first will use a novel dataset with individual-level linkages of longitudinal data from a dementia registry, electronic health record, and Medicare claims (2006-17) to predict which patients with dementia-related diagnosis codes have true disease. We then will apply this approach to a national dataset of all TM beneficiaries to identify beneficiaries with dementia (2006-21), assess care patterns, and examine the impact of Medicare policy changes on beneficiaries' receipt of guideline-concordant dementia care. We will exploit a natural experiment in which policy changes shift the distribution of patients in TM vs. MA within each county, i.e., changes in MA penetration because of mandated MA benchmark changes. Prior work has found that MA has better process quality compared to TM for some chronic conditions, e.g., diabetes, and that MA penetration favorably impacts guideline adherence and care in TM for such conditions. We will investigate the effect of MA penetration on dementia care within TM. We have three aims: Aim 1) Validation of a claims-based dementia definition among those who have a dementia diagnosis; Aim 2) Examination of the impact of MA penetration on guideline-concordant diagnostic evaluation for TM dementia patients; and Aim 3) Examination of the impact of MA penetration on guideline-concordant treatments for TM dementia patients. In summary, we will apply modern data science approaches to identify the patients in the Medicare program who have dementia, then examine how changes in the Medicare program affects dementia care within each county in the United States. These Medicare policy changes both help generate evidence and could lend themselves to future interventions to improve dementia care, e.g., through adjustments in Medicare quality incentives. Moreover, these data could help inform patients, families, clinicians, and policy makers about how we can improve care for this rapidly expanding population of patients.

抽象的：数以百万计的美国人患有阿尔茨海默氏病和相关痴呆症（“痴呆症”），还有数百万预计将在接下来的几十年中发展；痴呆症是一种改变生活的状况相关的发病率。这些患者大多数是医疗保险受益人。随着新的治疗即将到来，由于这种治疗的潜在成本，将来有望改善和风险加上越来越多的患者，尤其是患者，家庭和患者的财政菌株风险 Medicare计划（到2050年，总支出估计达到每年1万亿美元）。尽管有希望风险，关于传统的服务费用医疗保险，有关当前痴呆症护理的信息有限计划（又称TM），Medicare的两个组成部分（另一个组件是Medicare Advantage）（MA），由私人计划管理）。在全国范围内检查护理的一个主要障碍 Medicare计划是痴呆症诊断数据中不确定的有效性。为了解决这些问题，我们首先将使用一个新的数据集，该数据集具有痴呆登记中心纵向数据的个体链接，电子健康记录和Medicare主张（2006-17），以预测哪些与痴呆有关的患者诊断代码具有真正的疾病。然后，我们将把这种方法应用于所有TM的国家数据集受益人以痴呆症确定受益人（2006-21），评估护理模式并检查影响医疗保险政策的变更受益人收到指导方案的痴呆症护理。我们将利用一个政策变化的自然实验改变了在每个县内TM与MA中患者的分布，即，由于强制性的MA基准变化而导致MA穿透变化的变化。先前的工作发现马与某些慢性疾病（例如糖尿病）相比，与TM相比具有更好的过程质量穿透会对TM在此类条件下的指南遵守和护理有利。我们将调查 MA渗透对TM内痴呆症护理的影响。我们有三个目标：目标1）验证基于索赔的验证患有痴呆诊断的人的痴呆症定义；目标2）检查MA的影响对TM痴呆症患者的准则结合诊断评估的渗透；目标3）检查 MA渗透对TM痴呆症患者指南符合治疗的影响。总而言之，我们将采用现代数据科学方法来识别拥有的医疗保险计划中的患者痴呆症，然后检查医疗保险计划的变化如何影响每个县内的痴呆症护理美国。这些医疗保险政策的改变既有助于产生证据，又可以借给自己通过调整Medicare质量激励措施来改善痴呆症护理的未来干预措施。此外，这些数据可以帮助病人，家庭，临床医生和政策制定者告知我们如何改善这种快速扩大的患者人群的护理。