PDF(Pubmed)
Abstract：
UNASSIGNED: Lewy body dementia (LBD) is the second most common neurodegenerative dementia in the US, presenting unique end-of-life challenges.
UNASSIGNED: This study examined healthcare utilization and care continuity in the last year of life in LBD.
UNASSIGNED: Medicare claims for enrollees with LBD, continuously enrolled in the year preceding death, were examined from 2011-2018. We assessed hospital stays, emergency department (ED) visits, intensive care unit (ICU) admissions, life-extending procedures, medications, and care continuity.
UNASSIGNED: We identified 45,762 LBD decedents, predominantly female (51.8%), White (85.9%), with average age of 84.1 years (SD 7.5). There was a median of 2 ED visits (IQR 1-5) and 1 inpatient stay (IQR 0-2). Higher age was inversely associated with ICU stays (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI] 0.96-0.97) and life-extending procedures (OR 0.96; 95% CI 0.95-0.96). Black and Hispanic patients experienced higher rates of ED visits, inpatient hospitalizations, ICU admissions, life-extending procedures, and in-hospital deaths relative to White patients. On average, 15 (7.5) medications were prescribed in the last year. Enhanced care continuity correlated with reduced hospital (OR 0.72; 95% CI 0.70-0.74) and ED visits (OR 0.71; 95% CI 0.69-0.87) and fewer life-extending procedures (OR 0.71; 95% CI 0.64-0.79).
UNASSIGNED: This study underscored the complex healthcare needs of people with LBD during their final year, which was influenced by age and race. Care continuity may reduce hospital and ED visits and life-extending procedures.
UNASSIGNED: This study examined healthcare utilization and care continuity in the last year of life in LBD.
UNASSIGNED: Medicare claims for enrollees with LBD, continuously enrolled in the year preceding death, were examined from 2011-2018. We assessed hospital stays, emergency department (ED) visits, intensive care unit (ICU) admissions, life-extending procedures, medications, and care continuity.
UNASSIGNED: We identified 45,762 LBD decedents, predominantly female (51.8%), White (85.9%), with average age of 84.1 years (SD 7.5). There was a median of 2 ED visits (IQR 1-5) and 1 inpatient stay (IQR 0-2). Higher age was inversely associated with ICU stays (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI] 0.96-0.97) and life-extending procedures (OR 0.96; 95% CI 0.95-0.96). Black and Hispanic patients experienced higher rates of ED visits, inpatient hospitalizations, ICU admissions, life-extending procedures, and in-hospital deaths relative to White patients. On average, 15 (7.5) medications were prescribed in the last year. Enhanced care continuity correlated with reduced hospital (OR 0.72; 95% CI 0.70-0.74) and ED visits (OR 0.71; 95% CI 0.69-0.87) and fewer life-extending procedures (OR 0.71; 95% CI 0.64-0.79).
UNASSIGNED: This study underscored the complex healthcare needs of people with LBD during their final year, which was influenced by age and race. Care continuity may reduce hospital and ED visits and life-extending procedures.
摘要：
■路易体痴呆（LBD）是美国第二常见的神经退行性痴呆，呈现独特的生命终结挑战。
■这项研究调查了LBD生命最后一年的医疗保健利用和护理连续性。
■针对LBD参保人的医疗保险索赔，在死亡前一年连续登记，从2011-2018年进行了检查。我们评估了住院时间，急诊科（ED）访问，重症监护病房(ICU)入院,延长生命的程序，药物,和护理连续性。
■我们确定了45,762个LBD死者，以女性为主（51.8%），白色（85.9%），平均年龄84.1岁(SD7.5)。中位数为2次ED就诊（IQR1-5）和1次住院（IQR0-2）。较高的年龄与ICU住院（赔率比[OR]0.96;95％置信区间[CI]0.96-0.97）和延长寿命的程序（OR0.96;95％CI0.95-0.96）呈负相关。黑人和西班牙裔患者的ED就诊率较高，住院,ICU入院，延长生命的程序，以及与白人患者相关的住院死亡。平均而言,去年开了15（7.5）种药物。增强的护理连续性与住院次数减少（OR0.72;95％CI0.70-0.74）和ED访视次数减少（OR0.71;95％CI0.69-0.87）以及延长生命的程序减少（OR0.71;95％CI0.64-0.79）相关。
这项研究强调了LBD患者在最后一年的复杂医疗需求，受年龄和种族的影响。护理连续性可能会减少住院和ED就诊以及延长生命的程序。
■这项研究调查了LBD生命最后一年的医疗保健利用和护理连续性。
■针对LBD参保人的医疗保险索赔，在死亡前一年连续登记，从2011-2018年进行了检查。我们评估了住院时间，急诊科（ED）访问，重症监护病房(ICU)入院,延长生命的程序，药物,和护理连续性。
■我们确定了45,762个LBD死者，以女性为主（51.8%），白色（85.9%），平均年龄84.1岁(SD7.5)。中位数为2次ED就诊（IQR1-5）和1次住院（IQR0-2）。较高的年龄与ICU住院（赔率比[OR]0.96;95％置信区间[CI]0.96-0.97）和延长寿命的程序（OR0.96;95％CI0.95-0.96）呈负相关。黑人和西班牙裔患者的ED就诊率较高，住院,ICU入院，延长生命的程序，以及与白人患者相关的住院死亡。平均而言,去年开了15（7.5）种药物。增强的护理连续性与住院次数减少（OR0.72;95％CI0.70-0.74）和ED访视次数减少（OR0.71;95％CI0.69-0.87）以及延长生命的程序减少（OR0.71;95％CI0.64-0.79）相关。
这项研究强调了LBD患者在最后一年的复杂医疗需求，受年龄和种族的影响。护理连续性可能会减少住院和ED就诊以及延长生命的程序。
