Abstract：
OBJECTIVE: To document how dementia diagnoses appear in hospice claims, and how these different presentations reflect different hospice utilization. The reliance in the hospice literature on primary diagnosis, in addition to the focus on decedents, may underestimate the true presence of dementia in hospice, and little is known about the health care utilization of hospice patients with dementia as a secondary or not present diagnosis.
METHODS: Secondary data analysis of Medicare claims.
METHODS: Medicare beneficiaries with 2 or more dementia diagnoses from 2016 to 2018 electing hospice in 2018.
METHODS: Beneficiaries were classified based on the presence and position of dementia on their subset of hospice claims: primary diagnosis, secondary diagnosis, and not present. We then compared the demographics and utilization of the 3 claim-based categories of dementia beneficiaries in hospice in 2018.
RESULTS: Fewer than half of beneficiaries with a dementia diagnosis in all of their Medicare claims have dementia indicated as the primary diagnosis associated with their hospice claims, and 30% of beneficiaries did not have their diagnosed dementia appear at all on their hospice claims. Hospice length of stay and other utilization characteristics varied markedly across the 3 claim-based categories of dementia beneficiaries in hospice in 2018.
CONCLUSIONS: Collectively, International Classification of Diseases, Tenth Revision (ICD-10) coding and sequencing conventions, coding practices, and research methods related to hospice claim diagnoses may unintentionally underestimate and oversimplify how dementia manifests in hospice utilization.
METHODS: Secondary data analysis of Medicare claims.
METHODS: Medicare beneficiaries with 2 or more dementia diagnoses from 2016 to 2018 electing hospice in 2018.
METHODS: Beneficiaries were classified based on the presence and position of dementia on their subset of hospice claims: primary diagnosis, secondary diagnosis, and not present. We then compared the demographics and utilization of the 3 claim-based categories of dementia beneficiaries in hospice in 2018.
RESULTS: Fewer than half of beneficiaries with a dementia diagnosis in all of their Medicare claims have dementia indicated as the primary diagnosis associated with their hospice claims, and 30% of beneficiaries did not have their diagnosed dementia appear at all on their hospice claims. Hospice length of stay and other utilization characteristics varied markedly across the 3 claim-based categories of dementia beneficiaries in hospice in 2018.
CONCLUSIONS: Collectively, International Classification of Diseases, Tenth Revision (ICD-10) coding and sequencing conventions, coding practices, and research methods related to hospice claim diagnoses may unintentionally underestimate and oversimplify how dementia manifests in hospice utilization.
摘要：
目的：为了记录痴呆症的诊断如何出现在临终关怀索赔中，以及这些不同的演示如何反映不同的临终关怀利用。临终关怀文献中对初级诊断的依赖，除了关注死者，可能低估了临终关怀中痴呆症的真实存在，对临终关怀患者痴呆作为继发或不存在的诊断的医疗保健利用知之甚少。
方法：医疗保险索赔的二级数据分析。
方法：2016年至2018年有2例或以上痴呆症诊断的医疗保险受益人在2018年选择临终关怀。
方法：根据临终关怀索赔中痴呆的存在和位置对受益人进行分类：主要诊断，二级诊断,而不是在场。然后，我们比较了2018年临终关怀中3种基于索赔的痴呆症受益人的人口统计和利用率。
结果：在所有医疗保险索赔中，只有不到一半的被诊断为痴呆症的受益人将痴呆症列为与临终关怀索赔相关的主要诊断。和30％的受益人没有他们的诊断痴呆症出现在他们的临终关怀索赔。2018年，临终关怀住院时间和其他利用特征在临终关怀中的3种基于索赔的痴呆症受益人类别中差异显著。
结论：总的来说，国际疾病分类,第十次修订(ICD-10)编码和排序约定，编码实践，与临终关怀索赔诊断相关的研究方法可能无意中低估和过度简化了痴呆症在临终关怀利用中的表现。
方法：医疗保险索赔的二级数据分析。
方法：2016年至2018年有2例或以上痴呆症诊断的医疗保险受益人在2018年选择临终关怀。
方法：根据临终关怀索赔中痴呆的存在和位置对受益人进行分类：主要诊断，二级诊断,而不是在场。然后，我们比较了2018年临终关怀中3种基于索赔的痴呆症受益人的人口统计和利用率。
结果：在所有医疗保险索赔中，只有不到一半的被诊断为痴呆症的受益人将痴呆症列为与临终关怀索赔相关的主要诊断。和30％的受益人没有他们的诊断痴呆症出现在他们的临终关怀索赔。2018年，临终关怀住院时间和其他利用特征在临终关怀中的3种基于索赔的痴呆症受益人类别中差异显著。
结论：总的来说，国际疾病分类,第十次修订(ICD-10)编码和排序约定，编码实践，与临终关怀索赔诊断相关的研究方法可能无意中低估和过度简化了痴呆症在临终关怀利用中的表现。
