Dementia Care and Quality Improvement

Objectives: The objective of the proposed work is to thoroughly understand dementia care by enhancing evidence-based policy making as an approach to improve quality of care among people with dementia. This proposal is an epidemiological study that use population-based claims data from National Health Insurance Research Database (NHIRD) and the medical records from three affiliated hospitals of Taipei Medical University (TMU) to answer 1) the ability of using NHIRD claims to identify patients with dementia; 2) what’s disease profile of patients with dementia and how they are being treated; 3) how much we spend (resource utilization) on treating those patients and what are factors associated with resource utilization. Background: The prevalence of dementia is rising as population is aging. Recently, World Health Organization (WHO) raises awareness of dementia as a public health priority, and dementia can no longer be neglected but should be considered as part of the public health agenda. Current research in dementia focuses on disease prevention but research identifying modifiable risk factors of dementia is still in its beginning. To date, there is no treatment currently available to cure or even alter progressive course of dementia. However, demented people are at an increased risk of physical health problem and become increasingly dependent on health care services. A detail look at dementia care is important and necessary. It is a step towards improving the quality of life of people with dementia. Moreover, it can offer the evidence-based data for policy making as facing greater financial burden of caring patients with dementia. Material and Methods: The NHIRD claims records allow for the study of the cost and outcomes in broadly representative samples of persons, but it is not known the validity and reliability of claims for identifying patients with dementia as well as reflecting the severity of disease. Research suggested that adding drug prescription will improve the disease diagnosis. Stage of dementia might be able to measure indirectly when considering to combining the estimated median survival time among those patients. Thus, this proposal will link NHIRD claims and medical records to assess the accuracy of NHIRD claims of defining dementia cases and their staging. Algorithms of measures will be developed by combining data on diagnosis codes, drug prescription and death records. We will additionally use hospital-based medical records, in which contain functional outcomes and the results of cognitive rating scales to validate their predictive ability. For estimating the survival time and resource utilization, a retrospective matched cohort study will be conducted that the best control will be selected based on the propensity score. Cox proportional hazard regression will be used to estimate related risk of mortality by demented patients compared to those with normal cognition using a time-dependent covariate for dementia status. Generalized linear model and Two-Part model will be applied to estimate the health resource utilization with a smear transformation.