阿尔茨海默病和相关疾病患者的医疗保险潜在可避免住院治疗。
Potentially avoidable hospitalizations among Medicare beneficiaries with Alzheimer's disease and related disorders.
机构信息
Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
出版信息
Alzheimers Dement. 2013 Jan;9(1):30-8. doi: 10.1016/j.jalz.2012.11.002.
BACKGROUND
Individuals with Alzheimer's disease and related disorders (ADRD) have more frequent hospitalizations than individuals without ADRD, and some of these admissions may be preventable with proactive outpatient care.
METHODS
This study was a cross-sectional analysis of Medicare claims data from 195,024 fee-for-service ADRD beneficiaries aged ≥65 years and an equal number of matched non-ADRD controls drawn from the 5% random sample of Medicare beneficiaries in 2007-2008. We analyzed the proportion of patients with potentially avoidable hospitalizations (PAHs, as defined by the Medicare Ambulatory Care Indicators for the Elderly) and used logistic regression to examine patient characteristics associated with PAHs. We used paired t tests to compare Medicare expenditures by ADRD status, stratified by whether there were PAHs related to a particular condition.
RESULTS
Compared with matched non-ADRD subjects, Medicare beneficiaries with ADRD were significantly more likely to have PAHs for diabetes short-term complications (OR = 1.43; 95% CI 1.31-1.57), diabetes long-term complications (OR = 1.08; 95% CI = 1.02-1.14), and hypertension (OR = 1.22; 95% CI 1.08-1.38), but less likely to have PAHs for chronic obstructive pulmonary disease (COPD)/asthma (OR = 0.85; 95% CI 0.82-0.87) and heart failure (OR = 0.89; 95% CI 0.86-0.92). Risks of PAHs increased significantly with comorbidity burden. Among beneficiaries with a PAH, total Medicare expenditures were significantly higher for those subjects who also had ADRD.
CONCLUSION
Medicare beneficiaries with ADRD were at a higher risk of PAHs for certain uncontrolled comorbidities and incurred higher Medicare expenditures compared with matched controls without dementia. ADRD appears to make the management of some comorbidities more difficult and expensive. Ideally, ADRD programs should involve care management targeting high-risk patients with multiple chronic conditions.
背景
患有阿尔茨海默病和相关疾病（ADRD）的个体比没有 ADRD 的个体有更多的住院治疗，其中一些住院治疗可能可以通过积极的门诊护理来预防。
方法
这是一项对 195024 名年龄≥65 岁的 Medicare 服务 ADRD 受益人和从 2007-2008 年 Medicare 受益人的 5%随机样本中抽取的 195024 名匹配的非 ADRD 对照者的 Medicare 索赔数据进行的横断面分析。我们分析了潜在可避免住院治疗（PAHs）的患者比例（根据 Medicare 老年门诊护理指标定义），并使用逻辑回归检查与 PAHs 相关的患者特征。我们使用配对 t 检验比较了 ADRD 状态下的 Medicare 支出，根据与特定疾病相关的 PAHs 进行分层。
结果
与匹配的非 ADRD 受试者相比，ADRD 患者因糖尿病短期并发症（OR = 1.43；95%CI 1.31-1.57）、糖尿病长期并发症（OR = 1.08；95%CI = 1.02-1.14）和高血压（OR = 1.22；95%CI 1.08-1.38）发生 PAHs 的可能性显著更高，但因慢性阻塞性肺疾病（COPD）/哮喘（OR = 0.85；95%CI 0.82-0.87）和心力衰竭（OR = 0.89；95%CI 0.86-0.92）发生 PAHs 的可能性显著更低。PAHs 的风险随着合并症负担的增加而显著增加。在有 PAHs 的受益人群中，那些同时患有 ADRD 的患者的 Medicare 总支出显著更高。
结论
与没有痴呆的匹配对照组相比，患有 ADRD 的 Medicare 受益人群因某些未得到控制的合并症发生 PAHs 的风险更高，并且 Medicare 支出也更高。ADRD 似乎使某些合并症的管理更加困难和昂贵。理想情况下，ADRD 计划应涉及针对患有多种慢性疾病的高危患者的护理管理。
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