Stuart Bruce, Gruber-Baldini Ann L, Fahlman Cheryl, Quinn Charlene C, Burton Lynda, Zuckerman Illene H, Hebel J Rich, Zimmerman Sheryl, Singhal Puneet K, Magaziner Jay
The Peter Lamy Center on Drug Therapy and Aging, Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, 515 W. Lombard Street, Suite 157, Baltimore, MD 21201, USA.
Gerontologist. 2005 Aug;45(4):505-15. doi: 10.1093/geront/45.4.505.
Our objective in this study was to compare Medicare costs of treating older adults with and without dementia in nursing home settings.
An expert panel established the dementia status of a stratified random sample of newly admitted residents in 59 Maryland nursing homes between 1992 and 1995. Medicare expenditures per-person month (PPM) were compared for 640 residents diagnosed with dementia and 636 with no dementia for 1 year preadmission and 2 years postadmission. Multivariate analysis with generalized estimating equations was used to identify the source of Medicare cost differentials between the two groups.
Medicare expenditures peaked in the month immediately preceding admission and dropped to preadmission levels by the third month in a nursing home. Adjusted PPM costs postadmission for the dementia group as a whole were 79% (p < .001) of the Medicare costs of treating residents without dementia. For the subgroup of residents admitted without a Medicare qualified stay (MQS), those with dementia had Medicare costs of just 63% (p < .001) of those without dementia. Overall Medicare costs PPM were insignificantly different between the two groups admitted with a MQS.
Whether nursing home residents are admitted with a MQS is the single most important factor in assessing treatment cost differentials between residents admitted with and without dementia. Failure to consider this factor may lead researchers and policy makers to misdirect their attention from the true source of the differential-dementia patients admitted without a qualifying stay.
本研究的目的是比较在养老院环境中治疗患有和未患有痴呆症的老年人的医疗保险费用。
一个专家小组确定了1992年至1995年间马里兰州59家养老院新入院居民分层随机样本的痴呆症状况。比较了640名被诊断患有痴呆症的居民和636名未患痴呆症的居民入院前1年和入院后2年的人均每月医疗保险支出（PPM）。使用广义估计方程进行多变量分析，以确定两组之间医疗保险费用差异的来源。
医疗保险支出在入院前一个月达到峰值，并在养老院的第三个月降至入院前水平。痴呆症组入院后的调整后PPM成本总体上是治疗非痴呆症居民医疗保险成本的79%（p < .001）。对于那些没有符合医疗保险资格停留（MQS）条件而入院的居民亚组，患有痴呆症的居民的医疗保险成本仅为没有痴呆症居民的63%（p < .001）。有MQS条件入院的两组居民之间的总体医疗保险成本PPM没有显著差异。
养老院居民是否有MQS条件入院是评估患有和未患有痴呆症的入院居民治疗成本差异的最重要单一因素。不考虑这一因素可能会导致研究人员和政策制定者将注意力从差异的真正来源——没有符合条件停留而入院的痴呆症患者身上转移开。
