在收费服务医疗保险受益者之间,初始痴呆症诊断的设置差异不同
Elizabeth M White1, Thomas Bayer2,3, Cyrus M Kosar1
1Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Journal of the American Geriatrics Society
|October 22, 2024
概括
与社区诊断相比,在医院或养老院诊断痴呆与生存率显著降低有关. 这凸显了需要更好的痴呆症查,特别是在农村和服务不足的地区.
科学领域:
- 老年学是一门学科.
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 及时诊断痴呆症对于明智的决策和资源获取至关重要.
- 延迟或错过的诊断,通常在住院或养老院入院期间发现,可能表明医疗保健获取差异.
- 了解痴呆症诊断的设置对于改善患者结果至关重要.
研究的目的:
- 检查医疗保险受益者之间痴呆症诊断设置的变化.
- 评估人口和地理因素与诊断位置的关联.
- 评估相对于诊断设置的4年生存率.
主要方法:
- 使用医疗保险索赔和行政数据 (2012-2020) 的回顾性队列研究.
- 对2016年初始痴呆症诊断的收费医疗保险受益人的分析.
- 诊断位置因子的多项逻辑回归和生存分析的Cox比例危险回归.
主要成果:
- 分析了超过75万名受益者,60.3%在社区诊断,17.2%在医院诊断,22.5%在养老院诊断.
- 对那些在医院 (-16.1%) 和养老院 (-16.8%) 诊断的患者而言,生存率明显低于社区.
- 社区诊断的个人在人口和社会经济方面更为多样化;农村受益者更有可能在医院被诊断出来.
结论:
- 很大一部分老年人在不理想的环境 (医院,养老院) 中接受痴呆症诊断.
- 在这些情况下的诊断与生存率显著降低有关,这表明晚期诊断或急性疾病.
- 迫切需要在一般人群中改善痴呆症查,特别是在农村和社会贫困地区.
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