Reed Peter S, Kim Yonsu, Shen Jay J, Kosaraju Sai, Kang Mingon, Carson Jennifer, Chaudhry Iulia Ioanitoaia, Kim Sarah, Jeong Connor, Hwang Yena, Yoo Ji Won
Sanford Center for Aging, School of Medicine, University of Nevada, Reno, Reno, NV 89557, USA.
Department of Health Behavior, Policy and Administration Sciences, School of Public Health, University of Nevada, Reno, Reno, NV 89557, USA.
Int J Environ Res Public Health. 2025 Sep 7;22(9):1399. doi: 10.3390/ijerph22091399.
Identifying strategies to enhance patient engagement and to control healthcare costs promotes a responsive and efficient healthcare system. The aim of this study is to predict healthcare cost savings associated with delivering telehealth advance care planning (ACP) to patients living with dementia. Two Geriatrics Workforce Enhancement Programs delivered training to primary care providers on using telehealth to provide ACP. Using electronic health records data from 6344 dual-eligible Medicare/Medicaid patients receiving telehealth primary care from trained providers in an urban safety net system, persons living with dementia ( = 401) were identified by extracting ICD-10 codes. The primary outcome was the estimated hospitalization-associated cost, with a key independent variable of ACP billing status. Multiple linear regressions and machine learning techniques estimated the impact of telehealth ACP on hospitalization-associated costs with a differential analysis by race. Compared to non-Hispanic Whites, hospitalization costs among Hispanic elders were higher by USD 14,232.40. Costs for non-English speakers or those having increased comorbidities were higher by USD 27,346.60 and USD 26,072.70, respectively. Overall, receiving ACP was associated with lower costs of USD 23,928.84. Dementia patients seen by primary care providers in a system receiving training to offer ACP via telehealth realized significant cost savings, with marked differences among those of non-White racial backgrounds.
确定提高患者参与度和控制医疗成本的策略，有助于建立一个反应迅速且高效的医疗体系。本研究的目的是预测为痴呆症患者提供远程医疗预先护理计划（ACP）所带来的医疗成本节省。两个老年医学劳动力增强项目为初级保健提供者提供了关于使用远程医疗提供ACP的培训。利用来自城市安全网系统中6344名接受过培训的提供者提供远程医疗初级保健的双重资格医疗保险/医疗补助患者的电子健康记录数据，通过提取ICD-10编码识别出痴呆症患者（n = 401）。主要结果是估计的与住院相关的成本，关键自变量是ACP计费状态。多元线性回归和机器学习技术估计了远程医疗ACP对与住院相关成本的影响，并按种族进行了差异分析。与非西班牙裔白人相比，西班牙裔老年人的住院成本高出14,232.40美元。非英语使用者或合并症增加者的成本分别高出27,346.60美元和26,072.70美元。总体而言，接受ACP与降低23,928.84美元的成本相关。在一个接受过通过远程医疗提供ACP培训的系统中，由初级保健提供者诊治的痴呆症患者实现了显著的成本节省，不同非白人种族背景的患者之间存在明显差异。
