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：数百万美国人患有阿尔茨海默病和相关痴呆症（“痴呆症”），还有数百万人患有阿尔茨海默病和相关痴呆症（“痴呆症”），还有数百万人患有阿尔茨海默病和相关痴呆症（“痴呆症”）预计在未来几十年内会出现痴呆症，这是一种改变生活的疾病，其发病率很高；这些患者中的大多数都是医疗保险受益人，新的治疗方法即将出现。由于此类治疗的潜在成本，既有未来改善的希望，也存在风险加上患者数量不断增加，特别是患者、家庭和患者面临财政紧张的风险医疗保险计划（到 2050 年总支出预计将达到 1 万亿美元/年）。和风险，传统按服务收费医疗保险中有关当前痴呆症护理的信息有限计划（又名 TM），Medicare 两个组成部分中较大的一个（另一个组成部分是 Medicare Advantage （MA），由私人计划管理）。医疗保险计划中痴呆症诊断的有效性不确定，为了解决这些问题，我们。首先将使用一个新颖的数据集，该数据集与痴呆症登记处的纵向数据进行个体层面的联系，电子健康记录和医疗保险索赔 (2006-17) 来预测哪些患者患有痴呆症相关然后我们会将这种方法应用于所有 TM 的国家数据集。受益人确定患有痴呆症的受益人（2006-21），评估护理模式并检查影响关于接受者接受符合指南的痴呆症护理的医疗保险政策的变化我们将利用自然实验，其中政策变化改变了每个县内 TM 与 MA 患者的分布，即，由于强制 MA 基准变化而导致 MA 渗透率发生变化。对于某些慢性疾病（例如糖尿病），与 TM 相比，MA 具有更好的流程质量渗透率对此类情况的 TM 指南遵守和护理产生有利影响。 MA 渗透对 TM 内痴呆症护理的影响我们有三个目标：目标 1) 验证基于索赔的结果。痴呆症诊断患者的痴呆定义；目标 2) 检查 MA 的影响对 TM 痴呆患者进行符合指南的诊断评估的渗透；以及目标 3) 检查； MA 渗透率对 TM 痴呆患者指南一致治疗的影响总之，我们。将应用现代数据科学方法来识别医疗保险计划中的患者痴呆症，然后研究医疗保险计划的变化如何影响该地区每个县的痴呆症护理美国这些医疗保险政策的变化既有助于产生证据，也可能有助于未来改善痴呆症护理的干预措施，例如通过调整医疗保险质量激励措施。此外，这些数据可以帮助患者、家属、忠诚者和政策制定者了解我们如何能够改善对这一迅速扩大的患者群体的护理。