メディケアの慢性疾患ファイルの変化と認知症の特定における格差
Rajesh Makineni1, Aaron Bloschichak1, Helena Temkin-Greener1
1Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Journal of the American Medical Directors Association
|September 6, 2025
まとめ
慢性疾患 の 倉庫
科学分野:
- ゲロントロジー
- 公衆衛生
- 医療サービス研究
背景:
- 慢性状態倉庫 (CCW) は2022年に慢性状態ファイルを27状態 (CC27) から30状態 (CC30) に更新しました.
- CC30ファイルは認知症の識別基準に変更を加え,回顧期間を短縮し,請求要件を増加させました.
- これらの変更は,特に脆弱な集団の認知症症例の特定に影響を与える可能性があります.
研究 の 目的:
- CC27からCC30への移行が様々な人口および地理的サブグループで認知症の特定に与える影響を定量化する.
- 認知症の診断の不一致に関連した個人レベル (人種/民族,双重地位,年齢,性別) と地域レベル (提供者不足,社会的欠乏) の要因を調査する.
- アルツハイマー病 (AD) とアルツハイマー病および関連認知症 (ADRD) の症例特定に対する更新されたCCWデータの効果を評価する.
主な方法:
- 公的に利用可能なデータとリンクされたメディケア受益者概要ファイル (2018-2021) を利用した観察研究.
- CC27とCC30の両方の基準を用いてADまたはADRDの受益者を特定する.
- CC27とCC30の認知症識別における不一致に関連した要因を決定するためのロジスティック回帰分析
主要な成果:
- CC30ファイルは,CC27によって以前に特定されたADとADRDの症例の70~72%しか特定できず,新しい症例はごくわずか (0.04%) であった.
- 認知症の識別における不一致は,患者およびコミュニティの特徴と有意に関連していました.
- アジア系とヒスパニック系受益者,農村部住民,社会経済的に恵まれない地域の人々は,ADRDの特定において意見の相違率が高いことを示しました.
結論:
- CC27からCC30への移行は,特定されたADとADRDの症例の減少につながり,特定のサブ集団に不釣り合いに影響しました.
- 研究者や政策立案者が 認知症の傾向を解釈し 介護介入策を策定する際に これらの変化を慎重に検討する必要があるのです
- この結果は,データ更新による認知症の識別における潜在的な格差を強調しています.
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