Murman Daniel L, Von Eye Alexander, Sherwood Paula R, Liang Jersey, Colenda Christopher C
Department of Neurological Sciences, University of Nebraska Medical Center, 982045 Nebraska Medical Center, Omaha, NE 68198, USA.
Alzheimer Dis Assoc Disord. 2007 Jan-Mar;21(1):39-48. doi: 10.1097/WAD.0b013e31802f2426.
The purpose of this study was to examine the strength of the associations between 5 measures of need that are potentially modifiable in degenerative dementia patients and direct costs of care from 5 payer perspectives in the US healthcare system. Data were derived from a cohort study of 150 patients with a degenerative dementia. We measured need variables at baseline and utilization of healthcare in the year before and after baseline. Utilization data were converted into estimated direct costs and totaled based on the costs paid for by 5 payers in the US healthcare system. Path models were used to quantify and compare the relationships between need variables and direct costs. From Medicare's perspective, comorbid medical conditions were the most important predictor of Medicare costs. From Medicaid's perspective, neuropsychiatric symptoms and signs of parkinsonism were additional significant predictors. From the perspective of patients, their families and society, all 5 need variables were significant predictors of direct costs (ie, those above, plus cognitive impairment, and dependency). The relationship between evaluated need variables and direct costs depends on the perspective of the payer and provide insights into which need variables could be targeted with interventions to control costs and improve patient outcomes.
本研究的目的是在美国医疗保健系统中，从5个付款方的角度，考察5种需求指标（这些指标在退行性痴呆患者中可能是可改变的）与护理直接成本之间关联的强度。数据来源于一项对150例退行性痴呆患者的队列研究。我们在基线时测量需求变量，并测量基线前后一年的医疗保健利用率。利用率数据被转换为估计的直接成本，并根据美国医疗保健系统中5个付款方支付的成本进行汇总。路径模型用于量化和比较需求变量与直接成本之间的关系。从医疗保险的角度来看，合并症是医疗保险成本的最重要预测因素。从医疗补助的角度来看，神经精神症状和帕金森症体征是另外的重要预测因素。从患者、其家庭和社会的角度来看，所有5个需求变量都是直接成本的重要预测因素（即上述因素，加上认知障碍和依赖）。评估的需求变量与直接成本之间的关系取决于付款方的角度，并为哪些需求变量可以通过干预措施来控制成本和改善患者结局提供了见解。
