School of Nursing, University of Texas Medical Branch, Galveston.
Sealy Center on Aging, University of Texas Medical Branch, Galveston.
JAMA Netw Open. 2024 Oct 1;7(10):e2437247. doi: 10.1001/jamanetworkopen.2024.37247.
Early recognition of cognitive impairment is key to optimal dementia care. No previous research has examined the probability of developing mild cognitive impairment (MCI) or Alzheimer disease and related dementias (ADRD) at 5-year follow-up among older adult Medicare beneficiaries by receipt of an annual wellness visit (AWV).
To assess the association of incident AWV with the first ADRD or MCI diagnosis among older adults with Medicare fee-for-service benefits.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective population-based cohort study used 100% Texas fee-for-service Medicare data from 2015 to 2022. Participants comprised 549 516 community-dwelling Medicare beneficiaries aged 68 years or older in 2018, with complete Medicare fee-for-service Parts A and B and no Medicare Advantage plan enrollment for 2015 to 2018.
Medicare AWVs.
The first MCI or ADRD diagnosis (reported as MCI or ADRD diagnosis, MCI diagnosis, and ADRD diagnosis) from the AWV index date in 2018 through December 31, 2022.
In this cohort study of 549 516 Medicare beneficiaries with no diagnosis of MCI or ADRD in 2015 to 2017 (mean [SD] age, 76.7 [6.6] years; 289 932 women [52.8%]), 66 433 (12.1%) had an incident AWV in 2018. Annual wellness visit recipients were more likely than those who did not receive an AWV to be female, to be non-Hispanic White (followed by Hispanic, non-Hispanic Black, and other), to have more education, to reside in a metropolitan area, to have more comorbidities, and to have a primary care professional in the 12 months before the AWV index date. After propensity score matching, AWV receipt was associated with a 21% increase in MCI diagnosis (hazard ratio, 1.21 [95% CI, 1.16-1.27]) and a 4% increase in ADRD diagnosis (hazard ratio, 1.04 [95% CI, 1.02-1.06]). The increase in MCI diagnosis associated with AWV was larger when the AWV was censored or treated as a time-dependent covariate in the follow-up period.
These findings indicate that AWV recipients had a timelier first MCI diagnosis than those who did not receive an AWV, but first ADRD diagnosis differed little. This study suggests that the Medicare AWV health policy may increase MCI identification, prompting more specialized care.
早期识别认知障碍是优化痴呆症护理的关键。以前的研究没有调查在接受年度健康访视（AWV）的情况下，5 年后老年医疗保险受益人群中出现轻度认知障碍（MCI）或阿尔茨海默病及相关痴呆症（ADRD）的概率。
评估在有医疗保险费用服务的老年人中，新发 AWV 与 ADRD 或 MCI 首次诊断的相关性。
设计、地点和参与者：这是一项基于人群的回顾性队列研究，使用了 2015 年至 2022 年德克萨斯州 100%的医疗保险费用服务数据。参与者包括 2018 年年龄在 68 岁或以上、2015 年至 2018 年期间完全参加医疗保险费用服务 A 部分和 B 部分且未参加医疗保险优势计划的 549516 名社区居住的医疗保险受益人群。
医疗保险 AWV。
2018 年 AWV 索引日期至 2022 年 12 月 31 日首次 MCI 或 ADRD 诊断（报告为 MCI 或 ADRD 诊断、MCI 诊断和 ADRD 诊断）。
在这项针对 549516 名 2015 年至 2017 年无 MCI 或 ADRD 诊断的医疗保险受益人群的队列研究中（平均[标准差]年龄 76.7[6.6]岁；289932 名女性[52.8%]），2018 年有 66433 名（12.1%）新发 AWV。与未接受 AWV 的人群相比，接受年度健康访视的人群更可能为女性，更可能是非西班牙裔白人（其次是西班牙裔、非西班牙裔黑人及其他族裔），受教育程度更高，居住在大都市区，合并症更多，且在 AWV 索引日期前 12 个月内有初级保健专业人员。在进行倾向评分匹配后，接受 AWV 与 MCI 诊断增加 21%（风险比，1.21[95%置信区间，1.16-1.27]）和 ADRD 诊断增加 4%（风险比，1.04[95%置信区间，1.02-1.06]）相关。当 AWV 在随访期间被屏蔽或视为时间依赖性协变量时，与 AWV 相关的 MCI 诊断增加幅度更大。
这些发现表明，接受 AWV 的人群首次 MCI 诊断的时间比未接受 AWV 的人群更早，但首次 ADRD 诊断差异很小。本研究表明，医疗保险 AWV 健康政策可能会增加 MCI 的识别，从而促使提供更专业的护理。
