Identifying Approaches to Measure and Reduce Harmful, Low-Value Care Among Older Americans with Mild Cognitive Impairment and Dementia

确定衡量和减少患有轻度认知障碍和痴呆症的美国老年人的有害、低价值护理的方法

• 批准号: 10538630
• 负责人: John Mafi
• 金额: $ 52.57万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-12-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538630
• 关键词: Adult; Age; Aging; American; Area; Benzodiazepines; Caring; Caucasians; Characteristics; Clinical; Cognitive; Communities; Continuity of Patient Care; Control Groups; Cross-Sectional Studies; Data; Delirium; Dementia; Drug Prescriptions; Economics; Education; Elderly; Ethnic Origin; Etiology; Exposure to; Family; Foundations; Future; Guidelines; Health; Health Policy; Health Status; Health and Retirement Study; Health system; Hospitalization; Institution; Institutionalization; Interruption; Link; Literature; Longitudinal Studies; Measures; Medicare; Medicare claim; Methods; Morbidity - disease rate; Outcome; Patient Care; Patient-Focused Outcomes; Patients; Physicians; Policies; Policy Maker; Population; Procedures; Provider; Race; Research; Risk; Savings; Series; Services; Specific qualifier value; Subgroup; System; Testing; Time; Vulnerable Populations; Work; accountable care organization; care delivery; care seeking; cost; experience; falls; functional status; health equity; improved; mild cognitive impairment; payment; pilot test; poor health outcome; programs; screening; sex; trend

ABSTRACT Low-value care is patient care that provides no net benefit in specific clinical scenarios, and often causes harm. Older adults with mild cognitive impairment and dementia (MCID) frequently receive low-value care and are particularly vulnerable to its harms (e.g., routine benzodiazepine drug prescriptions offer limited benefit to adults with MCID and can cause delirium or falls). Reducing the delivery of low-value care can improve health outcomes for this vulnerable group by lessening exposure to harms as well as curtailing unnecessary spending. To begin to reduce the problem of low-value care delivery in older adults with MCID, it is important to understand the extent of the national problem, identify the characteristics of patients and the delivery systems with the greatest risk exposure, and whether two currently implemented U.S. strategies (payment reform and a large education campaign) were associated with less delivery of low-value care among older adults with MCID. In this context, we propose three specific aims: 1) to generate national estimates of low-value care trends, costs, and harms in older adults with MCID (2008–2018), 2) to identify subgroups of older adults with MCID at the greatest risk of receiving low-value care, and 3) to assess whether two U.S. strategies were associated with less low-value care delivered to older adults with MCID. We propose to achieve these aims by linking Medicare claims data with the Health and Retirement Study (HRS), which is a nationally representative longitudinal study of community-dwelling and institutionalized older Americans on the health and economic changes of aging. We will pursue these aims using national longitudinal data and by applying rigorous analytical approaches such as interrupted time series methods with contemporaneous control groups. Ultimately, we seek to build a foundation of evidence to inform future U.S. health policies that can reduce low-value care and improve patient-oriented outcomes in older Americans with MCID.

抽象的 低价值护理是指在特定临床情况下无法提供净效益的患者护理，并且通常会导致 患有轻度认知障碍和痴呆症 (MCID) 的老年人经常接受低价值的护理和治疗。 特别容易受到其危害（例如，常规苯二氮卓类药物处方对以下人群的益处有限） 患有 MCID 的成年人，可能导致谵妄或跌倒）。减少低价值护理的提供可以改善健康。 通过减少伤害以及减少不必要的行为，为这一弱势群体带来成果 为了开始减少 MCID 老年人的低价值护理服务问题，重要的是： 了解国家问题的严重程度，确定患者和输送系统的特征 风险敞口最大的国家，以及美国当前实施的两项战略（支付改革和 大型教育活动）与 MCID 老年人中提供低价值护理的减少有关。 在这种背景下，我们提出三个具体目标：1）对低价值护理趋势进行全国估计， 患有 MCID 的老年人的成本和危害（2008-2018 年），2) 以确定患有 MCID 的老年人亚组 接受低价值护理的最大风险，以及 3) 评估两种美国策略是否相关 向 MCID 老年人提供的低价值护理较少。 我们建议通过将医疗保险索赔数据与健康和退休研究联系起来来实现这些目标 （HRS），这是一项针对社区居住和机构化老年人的全国代表性纵向研究 美国人在老龄化的健康和经济变化方面将利用国家力量来实现这些目标。 纵向数据并应用严格的分析方法，例如中断时间序列方法 最终，我们寻求建立证据基础来为未来的美国提供信息。 可以减少低价值护理并改善美国老年人以患者为导向的结果的卫生政策 MCID。