Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Department of Social and Behavioral Sciences, University of California San Francisco School of Nursing, San Francisco, California, USA.
Alzheimers Dement. 2023 Sep;19(9):3946-3964. doi: 10.1002/alz.13052. Epub 2023 Apr 18.
Older adults with Alzheimer's disease and related dementias (ADRD) often face burdensome end-of-life care transfers. Advanced practice clinicians (APCs)-which include nurse practitioners and physician assistants-increasingly provide primary care to this population. To fill current gaps in the literature, we measured the association between APC involvement in end-of-life care versus hospice utilization and hospitalization for older adults with ADRD.
Using Medicare data, we identified nursing home- (N=517,490) and community-dwelling (N=322,461) beneficiaries with ADRD who died between 2016 and 2018. We employed propensity score-weighted regression methods to examine the association between different levels of APC care during their final 9 months of life versus hospice utilization and hospitalization during their final month.
For both nursing home- and community-dwelling beneficiaries, higher APC care involvement associated with lower hospitalization rates and higher hospice rates.
APCs are an important group of providers delivering end-of-life primary care to individuals with ADRD.
For both nursing home- and community-dwelling Medicare beneficiaries with ADRD, adjusted hospitalization rates were lower and hospice rates were higher for individuals with higher proportions of APC care involvement during their final 9 months of life. Associations between APC care involvement and both adjusted hospitalization rates and adjusted hospice rates persisted when accounting for primary care visit volume.
患有阿尔茨海默病和相关痴呆症（ADRD）的老年人在临终护理转移方面往往面临沉重负担。高级实践临床医生（APCs）——包括护士从业者和医师助理——越来越多地为这一人群提供初级保健。为了填补当前文献中的空白，我们测量了 APC 参与临终关怀与临终关怀利用和患有 ADRD 的老年人住院之间的关联。
使用医疗保险数据，我们确定了 2016 年至 2018 年间在疗养院（N=517490）和社区居住（N=322461）的患有 ADRD 的受益人的死亡情况。我们采用倾向评分加权回归方法来检查他们生命的最后 9 个月中 APC 护理的不同水平与临终关怀利用和最后一个月的住院之间的关联。
对于疗养院和社区居住的受益人均是，APC 护理的更高参与度与较低的住院率和较高的临终关怀率相关。
APC 是为患有 ADRD 的个人提供临终初级保健的重要提供者群体。
对于疗养院和社区居住的患有 ADRD 的 Medicare 受益人均是，在生命的最后 9 个月中 APC 护理的参与度较高的个体，其调整后的住院率较低，临终关怀率较高。当考虑到初级保健就诊量时，APC 护理参与度与调整后的住院率和调整后的临终关怀率之间的关联仍然存在。
