比较有和没有阿尔茨海默病及相关痴呆症的医疗保险优势受益人的护理体验。
Comparing the care experiences of Medicare Advantage beneficiaries with and without Alzheimer's disease and related dementias.
机构信息
Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
出版信息
J Am Geriatr Soc. 2022 Aug;70(8):2344-2353. doi: 10.1111/jgs.17817. Epub 2022 Apr 29.
BACKGROUND
The Medicare Advantage (MA) program is rapidly growing. Limited evidence exists about the care experiences of MA beneficiaries with Alzheimer's Disease and Related Dementia (ADRD). Our objective was to compare care experiences for MA beneficiaries with and without ADRD.
METHODS
We examined MA beneficiaries who completed the Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (CAHPS) and used inpatient, nursing home, or home health services in the past 3 years. We classified beneficiaries with ADRD using the presence of diagnosis codes in hospitals, nursing homes, and home health records. Our key measures included overall ratings of care and health plan, and indices of receiving timely care, care coordination, receiving needed care, and customer service. We compared differences between beneficiaries with and without ADRD using regression analysis adjusting for demographic, health, and plan characteristics, and stratifying by proxy response status.
RESULTS
Among beneficiaries sampled by CAHPS, 22.2% with ADRD completed the survey compared to 38.5% without ADRD. Among proxy responses, beneficiaries with ADRD were 4.2 (95% CI: 0.1-8.4) percentage points less likely to report a high score for receiving needed care, and 3.5 percentage points (95% CI: 0.2-6.9) less likely to report a high score for customer service. Among non-proxy responses, those with ADRD were 9.0 (95% CI: 5.5-12.5) percentage points less likely to report a high score for needed care, and 8.5 (95% CI: 5.4-11.5) percentage points less likely to report a high score for customer service.
CONCLUSIONS
ADRD respondents to the CAHPS were more likely to be excluded from CAHPS performance measures because they did not meet eligibility requirements and rates of non-response were higher. Among responders with or without a proxy, MA enrollees with an ADRD diagnosis reported worse care experiences in receiving needed care and in customer service than those without an ADRD diagnosis.
背景
医疗保险优势（MA）计划正在迅速发展。关于 MA 受益人与阿尔茨海默病和相关痴呆症（ADRD）的护理体验的证据有限。我们的目标是比较有和没有 ADRD 的 MA 受益人的护理体验。
方法
我们检查了在过去 3 年内完成医疗保险优势医疗保健提供者和系统消费者评估（CAHPS）并使用住院、疗养院或家庭保健服务的 MA 受益人的情况。我们使用医院、疗养院和家庭保健记录中的诊断代码来分类患有 ADRD 的受益人的情况。我们的关键措施包括对护理和医疗保健计划的总体评价，以及及时获得护理、护理协调、获得所需护理和客户服务的指数。我们使用回归分析比较了有和没有 ADRD 的受益人的差异，调整了人口统计学、健康和计划特征，并按代理响应状态进行分层。
结果
在 CAHPS 抽样的受益人中，有 ADRD 的受益人的调查完成率为 22.2%，而没有 ADRD 的受益人的调查完成率为 38.5%。在代理响应中，有 ADRD 的受益人的获得所需护理的高评分的可能性低 4.2（95%CI：0.1-8.4）个百分点，而获得客户服务的高评分的可能性低 3.5（95%CI：0.2-6.9）个百分点。在非代理响应中，患有 ADRD 的受益人的获得所需护理的高评分的可能性低 9.0（95%CI：5.5-12.5）个百分点，获得客户服务的高评分的可能性低 8.5（95%CI：5.4-11.5）个百分点。
结论
CAHPS 的 ADRD 受访者更有可能因不符合资格要求而被排除在 CAHPS 绩效措施之外，而且非响应率更高。在有或没有代理的响应者中，患有 ADRD 诊断的 MA 参保人在获得所需护理和客户服务方面的护理体验比没有 ADRD 诊断的参保人差。
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