Health Care Expenditures for Nursing Home Residents with Advanced Dementia

患有晚期痴呆症的疗养院居民的医疗保健支出

• 批准号: 8098379
• 负责人: DAVID C GRABOWSKI
• 金额: $ 26.43万
• 依托单位: HEBREW REHABILITATION CENTER FOR AGED
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8098379
• 关键词: Acute; Address; American; Applications Grants; Area; Attitude; Boston; Caring; Cause of Death; Cessation of life; Characteristics; Clinical; Cohort Studies; Data; Data Set; Dementia; Elderly; Expenditure; Family; Family Study; Family member; Foundations; Funding; Goals; Health Expenditures; Healthcare; Home Nursing Care; Hospitalization; Individual; Journals; Knowledge; Life; Link; Medicare; Medicare/Medicaid; Medicine; New England; Nursing Homes; Paper; Patient Preferences; Patients; Policies; Population; Proxy; Publishing; Research; Services; Skilled Nursing Facilities; Source; Staging; Time; United States National Institutes of Health; Variant; Work; administrative database; advanced dementia; cohort; cost; cost effective; end of life; experience; follow-up; hospice environment; improved; interest; outcome forecast; prospective; terminal patient care

DESCRIPTION (provided by applicant): Nursing home residents with advanced dementia commonly receive aggressive care near the end-of-life that can be burdensome and of questionable clinical benefit. However, the expenditures associated with caring for these residents have never been described and the factors influencing those expenditures are not known. The Choices, Attitudes, and Strategies for Care of Advanced Dementia at the End-of-Life (CASCADE) study was an NIH-funded prospective cohort study conducted between 2003-2009. The CASCADE study yielded a very rich dataset rigorously detailing the course of a well-defined cohort of NH residents with advanced dementia and the experience of their family members followed for up to 18 months. In this R21 application, we propose to leverage the unique CASCADE dataset by linking it to Medicare and Medicaid claims files in order to describe and examine factors associated with the expenditures on care for NH residents with advanced dementia. This will be the first study of health care expenditures in this population. The following specific aims are proposed: Aim 1. To describe the Medicare and Medicaid expenditures on care for 317 NH residents with advanced dementia living in 22 Boston area facilities between 2003 and 2009. The analyses will identify the sources of spending variation, and examine factors associated with higher expenditures in these residents. Aim 2. To describe the Medicare and Medicaid expenditures on care for 258 decedents with advanced dementia from the CASCADE cohort across intervals prior to death (0-3 months, 3-6 months, 6-9 months, 9-12 months). Impact: Linking Medicare and Medicaid claims to an established, clinically rich dataset of a rigorously defined cohort of 317 NH residents with advanced dementia provides a unique opportunity to describe expenditures for treating this condition and examine factors associated with these expenditures. In addition, this exploratory work will provide preliminary data and the foundation for an NIH R01 grant application that will aim to use linked national datasets to study health care spending on advanced dementia on a larger scale. Taken together, the proposed work represents the first step towards planning services and policies that promote end-of-life care in advanced dementia that is of high quality, consistent with patient preferences, and cost-effective. PUBLIC HEALTH RELEVANCE: There has been much interest among policymakers in the costs of caring for nursing home patients with advanced dementia. By linking administrative claims data with unique clinical information collected from advanced dementia patients and their families, this study provides an opportunity to improve the efficiency of care for the millions of Americans that receive dementia care in the nursing home setting.

描述（由申请人提供）：患有晚期痴呆症的疗养院居民通常在临终时接受积极的护理，这可能是一种负担，而且临床效益也值得怀疑。然而，与照顾这些居民相关的支出从未被描述过，影响这些支出的因素也不得而知。晚期痴呆临终护理的选择、态度和策略 (CASCADE) 研究是 NIH 资助的一项前瞻性队列研究，于 2003 年至 2009 年期间进行。 CASCADE 研究产生了非常丰富的数据集，严格详细描述了一组明确的患有晚期痴呆症的 NH 居民的病程，以及对其家庭成员长达 18 个月的跟踪经历。在此 R21 应用程序中，我们建议利用独特的 CASCADE 数据集，将其链接到 Medicare 和 Medicaid 索赔文件，以描述和检查与患有晚期痴呆症的 NH 居民护理支出相关的因素。这将是对该人群医疗保健支出的首次研究。提出以下具体目标： 目标 1. 描述 2003 年至 2009 年间居住在波士顿地区 22 个设施的 317 名患有晚期痴呆症的新罕布什尔州居民的医疗保险和医疗补助支出。分析将确定支出变化的来源，并检查因素与这些居民较高的支出有关。目标 2. 描述来自 CASCADE 队列的 258 名晚期痴呆死者在死亡前不同时间段（0-3 个月、3-6 个月、6-9 个月、9-12 个月）的医疗保险和医疗补助护理支出。影响：将 Medicare 和 Medicaid 索赔与严格定义的 317 名患有晚期痴呆症的 NH 居民队列的已建立的、临床丰富的数据集联系起来，提供了一个独特的机会来描述治疗这种疾病的支出并检查与这些支出相关的因素。此外，这项探索性工作将为 NIH R01 拨款申请提供初步数据和基础，该申请旨在利用关联的国家数据集更大规模地研究晚期痴呆症的医疗保健支出。总而言之，拟议的工作代表了规划服务和政策的第一步，以促进高质量、符合患者偏好且具有成本效益的晚期痴呆症临终护理。 公共卫生相关性：政策制定者对护理疗养院晚期痴呆症患者的费用非常感兴趣。通过将行政索赔数据与从晚期痴呆症患者及其家人收集的独特临床信息联系起来，这项研究为提高数百万在疗养院接受痴呆症护理的美国人的护理效率提供了机会。