养老院成本比较对痴呆症诊断确定方法的敏感性。
Sensitivity of nursing home cost comparisons to method of dementia diagnosis ascertainment.
作者信息
Gruber-Baldini Ann L, Stuart Bruce, Zuckerman Ilene H, Hsu Van Doren, Boockvar Kenneth S, Zimmerman Sheryl, Kittner Steven, Quinn Charlene C, Hebel J Richard, May Conrad, Magaziner Jay
机构信息
Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
出版信息
Int J Alzheimers Dis. 2009 Sep 22;2009:780720. doi: 10.4061/2009/780720.
This study compared the association of differing methods of dementia ascertainment, derived from multiple sources, with nursing home (NH) estimates of prevalence of dementia, length of stay, and costs an understudied issue. Subjects were 2050 new admissions to 59 Maryland NHs, from 1992 to 1995 followed longitudinally for 2 years. Dementia was ascertained at admission from charts, Medicare claims, and expert panel. Overall 59.5% of the sample had some indicator of dementia. The expert panel found a higher prevalence of dementia (48.0%) than chart review (36.9%) or Medicare claims (38.6%). Dementia cases had lower relative average per patient monthly costs, but longer NH length of stay compared to nondementia cases across all methods. The prevalence of dementia varied widely by method of ascertainment, and there was only moderate agreement across methods. However, lower costs for dementia among NH admissions are a robust finding across these methods.
本研究比较了源自多种来源的不同痴呆确诊方法与养老院（NH）对痴呆患病率、住院时间和成本的估计之间的关联，这是一个研究较少的问题。研究对象为1992年至1995年间马里兰州59家养老院的2050名新入院患者，对其进行了为期2年的纵向随访。在入院时通过病历、医疗保险理赔记录和专家小组来确诊痴呆。总体而言，59.5%的样本有痴呆的某些指标。专家小组发现痴呆患病率（48.0%）高于病历审查（36.9%）或医疗保险理赔记录（38.6%）。与所有方法下的非痴呆病例相比，痴呆病例的相对平均每月每位患者成本较低，但在养老院的住院时间更长。痴呆的患病率因确诊方法的不同而有很大差异，且不同方法之间只有适度的一致性。然而，在这些方法中，养老院入院患者中痴呆患者成本较低是一个可靠的发现。
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