MODELING ALZHEIMER DISEASE COSTS AND TRANSITIONS

阿尔茨海默病成本和转变建模

基本信息

批准号：
7651716
负责人：
CHRISTOPHER M CALLAHAN
金额：
$ 63.04万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-15 至 2011-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7651716
关键词：
Address Affect Alzheimer&apos s Disease Ambulatory Care American Assisted Living Facilities Caring Categories Clinical Trials Clinics and Hospitals Cognitive Community Services Comprehensive Health Care Computerized Medical Record Continuity of Patient Care Cost Savings Cost of Illness Data Data Set Databases Dementia Diagnosis Discipline of Nursing Disease Effectiveness Elderly Family Caregiver Federal Government Frequencies Future Goals Health Healthcare Healthcare Systems Home Care Services Home Nursing Care Home environment Impaired cognition Information Systems Inpatients Intervention Intervention Studies Link Long-Term Care Medicaid Medicare claim Mental Health Metric Modeling Nursing Homes Outcome Patient Care Patients Patterns of Care Personal Financing Policies Population Primary Health Care Process Provider Randomized Clinical Trials Rehabilitation therapy Research Retirement Sampling Screening procedure Site Skilled Nursing Facilities Testing Time base clinical practice cognitive function cognitive impairment no dementia cohort collaborative care cost design disease natural history hospice environment improved medical specialties next generation primary care setting programs public health relevance

项目摘要

DESCRIPTION (provided by applicant): We recently completed a clinical trial testing the effectiveness of a care management program within primary care for older adults with Alzheimer's disease. Based on the clinical trial, which demonstrated the effectiveness of collaborative care, we identified the need for more comprehensive care models. These future models must address the fragmentation of care across multiple sites and providers beyond the primary care setting. To provide a more accurate picture of the entirety of care across the continuum of care, we must link data across multiple providers, health care systems, and payors. As part of the clinical trial recruitment process, we implemented a comprehensive cognitive screening and diagnosis program in primary care. Thus, we now have cognitive function data on 4,197 older primary care patients. This allows us to categorize patients into three mutually exclusive categories: dementia (n=147) cognitive impairment, no dementia (n=98); or no cognitive impairment (n=3,952). We can also track the process, outcomes, and costs of care within our health care system for all of these patients through access to clinical practice data in an advanced electronic medical record. However, these clinical practice data do not include care provided in the home or in skilled nursing facilities, for example. We now seek to establish a comprehensive database that would link our clinical trial and local electronic medical record system data with data from Medicare claims, Medicaid claims, and the Minimum Data Set. The long-range future goal of our research is to help design the next generation of care management interventions for older adults with Alzheimer's disease. The current project will allow us to identify targets for quality improvement and cost savings. This progression from descriptive epidemiologic to intervention studies is a hallmark of our past research. The specific aims of this project are to: 1) build a comprehensive longitudinal dataset across the continuum of care (home, ambulatory, inpatient, nursing home) for a large sample of vulnerable elders; 2) describe and compare the frequency and timing of transitions in care among older adults with dementia, cognitive impairment-no dementia, or normal; 3) describe and compare the costs of care across the continuum of care among older adults with dementia, cognitive impairment-no dementia, or normal; and 4) compare the findings from this cohort of urban poor older adults with findings from the nationally representative Health and Retirement Study (HRS). PUBLIC HEALTH RELEVANCE: Over 4.5 million Americans suffer from Alzheimer's disease. Federal, state, and personal finances are already strained to provide care for the current population, yet the number of older adults with Alzheimer's disease is expected to triple by 2050. Our research seeks to describe the costs and outcomes of care across the full continuum of health care for older adults with dementia. This descriptive data will help inform new treatment models.

描述（由申请人提供）：我们最近完成了一项临床试验，该试验测试了针对阿尔茨海默氏病老年人初级护理中护理管理计划的有效性。基于临床试验证明了协作护理的有效性，我们确定了对更全面的护理模型的需求。这些未来的模型必须解决除初级保健环境以外的多个站点和提供者之间护理的分裂。为了更准确地了解整个护理中的全部护理，我们必须将数据链接到多个提供商，医疗保健系统和付款人之间。作为临床试验招聘过程的一部分，我们在初级保健中实施了全面的认知筛查和诊断计划。因此，我们现在拥有4,197名老级保健患者的认知功能数据。这使我们可以将患者分为三个相互排斥的类别：痴呆（n = 147）认知障碍，无痴呆症（n = 98）；或没有认知障碍（n = 3,952）。我们还可以通过在先进的电子病历中获取临床实践数据来跟踪所有这些患者的医疗保健系统中的过程，结果和护理成本。但是，例如，这些临床实践数据不包括家庭或熟练护理设施中提供的护理。现在，我们寻求建立一个全面的数据库，该数据库将我们的临床试验和本地电子病历系统数据与Medicare索赔，Medicaid索赔和最低数据集的数据联系起来。我们研究的远程未来目标是帮助设计阿尔茨海默氏病老年人的下一代护理管理干预措施。当前的项目将使我们能够确定质量提高和节省成本的目标。从描述性流行病学到干预研究的发展是我们过去研究的标志。该项目的具体目的是：1）在整个护理（家庭，卧床，住院，疗养院，疗养院）中建立一个全面的纵向数据集，以构建大量脆弱的长老样本； 2）描述和比较老年人患有痴呆症，认知障碍 - 没有痴呆或正常的老年人中过渡过渡的频率和时机； 3）描述和比较痴呆症，认知障碍 - 没有痴呆或正常的老年人中整个护理的护理成本； 4）将这一城市贫困老年人队列的发现与全国代表性的健康和退休研究（HRS）的发现进行比较。公共卫生相关性：超过450万美国人患有阿尔茨海默氏病。联邦，州和个人理财已经很紧张地为当前人口提供护理，但是预计到2050年，患有阿尔茨海默氏病的老年人的数量预计将三倍。我们的研究旨在描述痴呆症老年人的全部医疗保健持续保健费用和护理的成本和结果。这些描述性数据将有助于为新的治疗模型提供信息。