医疗保险慢性病档案的变化和痴呆症识别的差异
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
概括
慢性病仓库
科学领域:
- 老年学
- 公共卫生
- 医疗服务研究
背景情况:
- 慢性病仓库 (CCW) 在2022年将其慢性病档案从27个条件 (CC27) 更新为30个条件 (CC30).
- CC30文件对痴呆症识别标准进行了修改,包括缩短回顾期和增加索赔要求.
- 这些修改可能会影响痴呆病例的识别,特别是在脆弱人群中.
研究的目的:
- 量化CC27到CC30在不同人口和地理小组的痴呆症识别的影响.
- 检查与痴呆症识别差异相关的个人层面因素 (种族/种族,双重身份,年龄,性别) 和区域层面因素 (供应商短缺,社会贫困).
- 评估更新的CCW数据对阿尔茨海默氏病 (AD) 和阿尔茨海默氏病及相关痴呆症 (ADRD) 病例鉴定的影响.
主要方法:
- 一项使用Medicare受益人摘要文件 (2018-2021) 与公开可用的数据相关的观察性研究.
- 使用CC27和CC30标准确定患有AD或ADRD的受益人.
- 后勤回归分析以确定与CC27和CC30之间痴呆症识别不一致相关的因素.
主要成果:
- 在CC30文件中,只有70-72%的AD和ADRD病例被CC27先前发现,新增的病例很少 (0.04%).
- 痴呆症识别的差异与患者和社区特征有显著联系.
- 亚裔和西班牙裔受益者,农村居民和社会经济贫困地区的受益者在ADRD识别中存在较高的分歧.
结论:
- 从CC27过渡到CC30导致确诊的AD和ADRD病例减少,不成比例地影响特定的亚群.
- 这些变化需要研究人员和政策制定者在解释痴呆症趋势和制定护理干预措施时仔细考虑.
- 这些发现突出了因数据更新修改而导致的痴呆症识别的潜在差异.
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