在综合医疗体系中 COVID-19 大流行期间新发痴呆症编码模式。
Patterns of incident dementia codes during the COVID-19 pandemic at an integrated healthcare system.
机构信息
Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington, USA.
Department of Family Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
出版信息
J Am Geriatr Soc. 2021 Dec;69(12):3389-3396. doi: 10.1111/jgs.17527. Epub 2021 Oct 25.
BACKGROUND
The COVID-19 pandemic delayed diagnosis and care for some acute conditions and reduced monitoring for some chronic conditions. It is unclear whether new diagnoses of chronic conditions such as dementia were also affected. We compared the pattern of incident Alzheimer's disease and related dementia (ADRD) diagnosis codes from 2017 to 2019 through 2020, the first pandemic year.
METHODS
Retrospective cohort design, leveraging 2015-2020 data on all members 65 years and older with no prior ADRD diagnosis, enrolled in a large integrated healthcare system for at least 2 years. Incident ADRD was defined as the first ICD-10 code at any encounter, including outpatient (face-to-face, video, or phone), hospital (emergency department, observation, or inpatient), or continuing care (home, skilled nursing facility, and long-term care). We also examined incident ADRD codes and use of telehealth by age, sex, race/ethnicity, and spoken language.
RESULTS
Compared to overall annual incidence rates for ADRD codes in 2017-2019, 2020 incidence was slightly lower (1.30% vs. 1.40%), partially compensating later in the year for reduced rates during the early months of the pandemic. No racial or ethnic group differences were identified. Telehealth ADRD codes increased fourfold, making up for a 39% drop from face-to-face outpatient encounters. Older age (85+) was associated with higher odds of receiving telecare versus face-to-face care in 2020 (OR:1.50, 95%CI: 1.25-1.80) and a slightly lower incidence of new codes; no racial/ethnic, sex, or language differences were identified in the mode of care.
CONCLUSIONS
Rates of incident ADRD codes dropped early in the first pandemic year but rose again to near pre-pandemic rates for the year as a whole, as clinicians rapidly pivoted to telehealth. With refinement of protocols for remote dementia detection and diagnosis, health systems could improve access to equitable detection and diagnosis of ADRD going forward.
背景
COVID-19 大流行延迟了一些急性病症的诊断和治疗，并减少了对一些慢性病症的监测。目前尚不清楚痴呆等慢性疾病的新诊断是否也受到了影响。我们比较了 2017 年至 2019 年（即大流行的第一年）与 2020 年期间，阿尔茨海默病和相关痴呆症（ADRD）诊断代码的新发情况。
方法
这是一项回顾性队列设计，利用 2015 年至 2020 年期间，在一个大型综合医疗系统中，至少有 2 年没有 ADRD 诊断的所有 65 岁及以上成员的数据。新发 ADRD 定义为任何就诊时的首次 ICD-10 编码，包括门诊（面对面、视频或电话）、医院（急诊、观察或住院）或持续护理（家庭、熟练护理设施和长期护理）。我们还按年龄、性别、种族/民族和语言检查了新发 ADRD 代码和远程医疗的使用情况。
结果
与 2017 年至 2019 年期间 ADRD 代码的总体年度发生率相比，2020 年的发生率略低（1.30%对 1.40%），部分原因是大流行早期月份的发病率下降。未发现任何种族或族裔群体差异。远程医疗 ADRD 代码增加了四倍，弥补了面对面门诊就诊减少的 39%。2020 年，年龄较大（85 岁以上）与远程护理而非面对面护理的可能性更高（OR：1.50，95%CI：1.25-1.80），新发代码的发生率略低；在护理模式方面，未发现种族/族裔、性别或语言差异。
结论
在大流行的第一年早期，ADRD 代码的发生率有所下降，但全年再次上升至接近大流行前的水平，因为临床医生迅速转向远程医疗。随着远程痴呆检测和诊断协议的不断完善，医疗系统可以改善获得公平的 ADRD 检测和诊断的机会。
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