Effect of Medicare Reimbursement for Care Planning on End of Life Care among Patients with Alzheimer's Disease and Related Dementias: A Quasi-Experimental Study

医疗保险报销护理计划对阿尔茨海默病和相关痴呆症患者临终护理的影响：一项准实验研究

• 批准号: 10690298
• 负责人: Jing Li
• 金额: $ 11.6万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10690298
• 关键词: Effect; Medicare; Reimbursement; Care; Planning

PROJECT SUMMARY Alzheimer's disease and Alzheimer's Disease-related dementias (AD/ADRD) are a leading cause of death in the U.S. More than 40% of all Medicare patients who die in a given year have AD/ADRD, and the number of deaths from AD/ADRD are fast growing. Dying individuals with AD/ADRD use more aggressive care at end of life, including burdensome transitions to the hospital and invasive procedures of questionable benefit, compared to those with no cognitive impairment. Advance care planning (ACP), the process of discussing and recording patient preferences for goals of care in the event of patient losing capacity, has been shown to decrease aggressive treatment and increase use of hospice and palliative care, in particular among AD/ADRD patients. Barriers to ACP exist, and no research has examined the causal effect of ACP on end-of-life (EOL) care among AD/ADRD patients using national data. This proposal addresses these gaps by examining two recent changes in Medicare reimbursement policy: the introduction of ACP billing codes on January 1, 2016, and the introduction of comprehensive care planning (CCP) billing codes on January 1, 2017. The CCP targets cognitively impaired patients and consists of several mandated components, including development, revision or review of an Advance Care Plan. No direct evidence exists on the effect of these two reimbursement changes on EOL care; in general or among AD/ADRD patients. This proposal will utilize Medicare claims data merged with several supplementary data sources to examine multiple physician and patient factors associated with ACP and CCP billing, and will innovatively apply two quasi-experimental study designs to separately examine the causal effect of ACP and CCP billing on EOL care spending and multiple measures of EOL care utilization commonly used as indicators for quality of EOL care, among AD/ADRD patients nationwide. Advanced statistical learning techniques will be employed to further correct bias and improve precision of causal estimates. The Specific Aims are: (1) To identify the physician and patient characteristics associated with ACP and CCP billing for AD/ADRD patients; (2) To determine the effect of ACP billing on EOL care utilization and spending among AD/ADRD patients using a Regression Discontinuity Design (RDD); (3) To determine the effect of CCP billing on EOL care utilization and spending among AD/ADRD patients using an Instrumental Variables (IV) approach. IMPACT: This project will provide rigorous and critical evidence to directly inform effective policies targeted at improving EOL care for AD/ADRD patients. Further, this K01 application will establish the applicant as one the few health economists with expertise in AD/ADRD, geriatrics and palliative care. It will prepare her to become an R01-funded independent investigator in policy evaluations that lead to improved quality of care and quality of life for the aging population, in particular AD/ADRD patients.

项目概要 阿尔茨海默病和阿尔茨海默病相关痴呆 (AD/ADRD) 是导致 在美国，在某一年死亡的所有 Medicare 患者中，超过 40% 患有 AD/ADRD，并且 因 AD/ADRD 死亡的人数正在快速增长。患有 AD/ADRD 的临终患者需要更积极的护理 在生命的尽头，包括到医院的繁重过渡和效益可疑的侵入性手术， 与没有认知障碍的人相比。预先护理计划 (ACP)，讨论和 事实证明，在患者丧失能力的情况下记录患者对护理目标的偏好 减少积极治疗并增加临终关怀和姑息治疗的使用，特别是在 AD/ADRD 患者中 患者。 ACP 存在障碍，并且没有研究检验 ACP 对寿命终止 (EOL) 的因果影响 使用国家数据对 AD/ADRD 患者进行护理。该提案通过审查两个方面来解决这些差距 医疗保险报销政策的最新变化：2016 年 1 月 1 日引入 ACP 账单代码， 并于 2017 年 1 月 1 日引入综合护理计划 (CCP) 计费代码。CCP 的目标 认知障碍患者，由几个强制组成部分组成，包括开发、修订 或审查预先护理计划。没有直接证据证明这两种报销的效果 EOL 护理的变化；一般情况下或 AD/ADRD 患者中。该提案将利用医疗保险索赔数据 与多个补充数据源合并，以检查多个相关的医生和患者因素 与ACP和CCP计费，并将创新性地应用两个准实验研究设计分别 检查 ACP 和 CCP 计费对 EOL 护理支出和 EOL 护理多种措施的因果影响 在全国 AD/ADRD 患者中，利用率通常被用作 EOL 护理质量的指标。 将采用先进的统计学习技术来进一步纠正偏差并提高准确性 因果估计。具体目标是： (1) 确定相关的医生和患者特征 AD/ADRD 患者的 ACP 和 CCP 账单； (2) 确定 ACP 计费对 EOL 护理的影响 使用断点回归设计 (RDD) 在 AD/ADRD 患者中使用和支出； (3) 至 使用以下方法确定 CCP 计费对 AD/ADRD 患者 EOL 护理利用率和支出的影响 工具变量（IV）方法。影响：该项目将为以下方面提供严格而关键的证据： 直接告知旨在改善 AD/ADRD 患者临终关怀的有效政策。此外，这款K01 申请将使申请人成为为数不多的在 AD/ADRD、老年病学方面具有专业知识的健康经济学家之一 和姑息治疗。这将使她做好成为 R01 资助的政策评估独立调查员的准备 从而提高老年人群（特别是 AD/ADRD 患者）的护理质量和生活质量。