Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
James J. Peters Veterans Affairs Medical Center, Bronx, New York.
J Am Geriatr Soc. 2019 Feb;67(2):269-276. doi: 10.1111/jgs.15638. Epub 2018 Oct 13.
To examine how misidentification of dementia affects estimation of Medicare costs in a largely minority cohort of participants for whom accurate in-person diagnoses are available.
Prospective cohort study.
Washington Heights-Inwood Columbia Aging Project, a multiethnic, population-based, prospective study of cognitive aging of Medicare beneficiaries aged 65 and older.
Individuals clinically diagnosed with dementia (n=495) and individuals clinically diagnosed without dementia (n=1,701).
Medicare claims-identified dementia was defined according to the presence of any International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for Alzheimer's disease and related dementias in all available claims during the study period. Participant characteristics associated with claims misidentification of dementia were estimated using logistic regression. Effects of dementia misidentification on Medicare expenditures were estimated using generalized linear models.
Medicare claims correctly identified 250 of the 495 (51%) dementia cases and 1,565 of the 1,701 (92%) nondementia cases. Sensitivity of claims-identified dementia was 0.51, and specificity was 0.92. Average annual Medicare expenditures were $14,721 for a beneficiary with a clinical diagnosis of dementia, and $18,208 for a beneficiary with claim-identified dementia, suggesting an overestimation of $3,487 per person per year when Medicare claims were used to identify dementia. Total annual expenditures for all beneficiaries with claims-identified dementia were $258,707 lower than that for all those who were clinically diagnosed, suggesting an overall underestimation of total Medicare expenditures if Medicare claims were used to identify dementia. Different types of misidentification have different effects on dementia-related cost estimates. Average annual expenditures per person were highest for false positives.
Misidentification of dementia in Medicare claims is common. Using claims to identify dementia may result in significantly biased estimates of the cost of dementia. J Am Geriatr Soc 67:269-276, 2019.
研究在一个主要由少数民族参与者组成的队列中，痴呆症的误诊如何影响医疗保险成本的估计，而这些参与者可以获得准确的面对面诊断。
前瞻性队列研究。
华盛顿高地-因伍德哥伦比亚老龄化项目，这是一项针对 65 岁及以上医疗保险受益人的多民族、基于人群、认知老龄化的前瞻性研究。
临床诊断为痴呆症的个体（n=495）和临床诊断为非痴呆症的个体（n=1,701）。
根据研究期间所有可用索赔中任何国际疾病分类，第九修订版，临床修正诊断阿尔茨海默病和相关痴呆症的代码，定义医疗保险索赔确定的痴呆症。使用逻辑回归估计与痴呆症索赔错误识别相关的参与者特征。使用广义线性模型估计痴呆症错误识别对医疗保险支出的影响。
医疗保险索赔正确识别了 495 例痴呆症病例中的 250 例（51%）和 1,701 例非痴呆症病例中的 1,565 例（92%）。索赔确定的痴呆症的敏感性为 0.51，特异性为 0.92。有临床诊断为痴呆症的受益人的平均年医疗保险支出为 14,721 美元，有索赔确定为痴呆症的受益人的平均年医疗保险支出为 18,208 美元，这表明每年每人高估了 3,487 美元。所有索赔确定为痴呆症的受益人的年总支出比所有临床诊断为痴呆症的受益人的支出低 258,707 美元，这表明如果使用医疗保险索赔来确定痴呆症，对医疗保险总支出的总体估计会存在低估。不同类型的错误识别对痴呆相关成本估计有不同的影响。假阳性的人均年支出最高。
医疗保险索赔中痴呆症的误诊很常见。使用索赔来识别痴呆症可能会导致痴呆症成本的估计产生显著偏差。美国老年学会杂志 67:269-276,2019.
