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 低价值护理是患者护理，在特定的临床情况下没有提供净益处，并且通常是原因 伤害。患有轻度认知障碍和痴呆（MCID）的老年人经常接受低价值护理和 特别容易受到危害（例如，常规的苯二氮卓类药物处方有限 成年人有MCID，可能导致ir妄或跌倒）。减少低价值护理的交付可以改善健康状况 通过减少对危害的暴露和减少不必要的损害，为这个脆弱的群体带来的成果 开支。为了开始减少MCID老年人低价值护理提供的问题，重要的是 了解国家问题的程度，确定患者的特征和交付系统 风险敞口最大，以及两个目前是否实施了美国战略（付款改革和 大型教育运动）与患有MCID的老年人的低价值护理交付相关。 在这种情况下，我们提出了三个具体目标：1）产生对低价值护理趋势的国家估计， 成本和MCID老年人的危害（2008- 2018年），2）确定具有MCID的老年人的亚组 接受低价值护理的最大风险，以及3）评估是否有两种美国策略 较少的低价值护理给有MCID的老年人。 我们建议通过将Medicare索赔数据与健康和退休研究联系起来来实现这些目标 （人力资源部 美国人在衰老的健康和经济变化方面。我们将使用民族来追求这些目标 纵向数据并应用严格的分析方法，例如中断的时间序列方法 同时对照组。最终，我们寻求建立证据的基础，以告知未来美国 可以减少低价值护理并改善老年美国人的健康政策 MCID。