连续性护理（COC）与淀粉样蛋白-β PET 扫描：CARE-IDEAS 研究。

Continuity of care (COC) and amyloid-β PET scan: the CARE-IDEAS study.

机构信息

Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.

Duke Clinical Research Institute, School of Medicine, Duke University, Durham, NC, USA.

出版信息

Alzheimers Res Ther. 2023 Jan 7;15(1):6. doi: 10.1186/s13195-022-01126-0.

DOI:10.1186/s13195-022-01126-0

PMID:36611213

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9824903/

Abstract

BACKGROUND

High continuity of care (COC) is associated with better clinical outcomes among older adults. The impact of amyloid-β PET scan on COC among adults with mild cognitive impairment (MCI) or dementia of uncertain etiology is unknown.

METHODS

We linked data from the CARE-IDEAS study, which assessed the impact of amyloid-β PET scans on outcomes in Medicare beneficiaries with MCI or dementia of uncertain etiology and their care partners, to Medicare claims (2015-2018). We calculated a participant-level COC index using the Bice-Boxerman formula and claims from all ambulatory evaluation and management visits during the year prior to and following the amyloid-β PET scan. We compared baseline characteristics by scan result (elevated or non-elevated) using standardized differences. To evaluate changes in COC, we used multiple regression models adjusting for sociodemographics, cognitive function, general health status, and the Charlson Comorbidity Index.

RESULTS

Among the 1171 cohort members included in our analytic population, the mean age (SD) was 75.2 (5.4) years, 61.5% were male and 93.9% were non-Hispanic white. Over two-thirds (68.1%) had an elevated amyloid-β PET scan. Mean COC for all patients was 0.154 (SD = 0.102; range = 0-0.73) prior to the scan and 0.158 (SD = 0.105; range = 0-1.0) in the year following the scan. Following the scan, the mean COC index score increased (95% CI) by 0.005 (-0.008, 0.019) points more for elevated relative to not elevated scan recipients, but this change was not statistically significant. There was no association between scan result (elevated vs. not elevated) or any other patient covariates and changes in COC score after the scan.

CONCLUSION

COC did not meaningfully change following receipt of amyloid-β PET scan in a population of Medicare beneficiaries with MCI or dementia of uncertain etiology. Future work examining how care continuity varies across marginalized populations with cognitive impairment is needed.

摘要

背景

高连续性护理（COC）与老年人更好的临床结局相关。淀粉样蛋白-β PET 扫描对轻度认知障碍（MCI）或病因不明的痴呆患者 COC 的影响尚不清楚。

方法

我们将 CARE-IDEAS 研究的数据与 Medicare 索赔（2015-2018 年）相关联，该研究评估了淀粉样蛋白-β PET 扫描对 Medicare 受益人的 MCI 或病因不明的痴呆及其护理伙伴的影响。我们使用 Bice-Boxerman 公式和 PET 扫描前一年和后一年所有门诊评估和管理就诊的 Medicare 索赔计算了参与者级别的 COC 指数。我们使用标准化差异比较了按扫描结果（升高或非升高）划分的基线特征。为了评估 COC 的变化，我们使用了多元回归模型，调整了社会人口统计学、认知功能、一般健康状况和 Charlson 合并症指数。

结果

在我们的分析人群中，有 1171 名队列成员，平均年龄（SD）为 75.2（5.4）岁，61.5%为男性，93.9%为非西班牙裔白人。超过三分之二（68.1%）的患者进行了淀粉样蛋白-β PET 扫描。所有患者的平均 COC 在扫描前为 0.154（SD=0.102；范围为 0-0.73），扫描后一年为 0.158（SD=0.105；范围为 0-1.0）。扫描后，升高的扫描组比不升高的扫描组 COC 指数平均增加了 0.005（95%CI：-0.008，0.019），但这种变化没有统计学意义。扫描结果（升高与不升高）或任何其他患者协变量与扫描后 COC 评分的变化之间没有关联。