Clustering 5-Year Multidimensional Health Care Trajectory Patterns in Alzheimer's Disease and Related Syndromes |
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| Affiliation: | 1. CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France;2. Université Toulouse III Paul Sabatier, Toulouse, France;3. Centre Hospitalier Universitaire de Toulouse, Department of Epidemiology and Public Health, Toulouse, France;4. Toulouse University Hospital, Toulouse, France;5. Department of Geriatrics, Montauban Hospital, Montauban, France;6. Department of Geriatrics, Toulouse University Hospital, Toulouse, France;7. Agence Régionale de Santé Occitanie, Toulouse, France;8. IRIT, University of Toulouse, Toulouse, France;1. Healthfirst, New York City, NY, USA;2. Eskenazi Health, Indiana University Center for Aging Research, Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN, USA;3. LeadingAge, Washington, DC, USA;4. Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, NC, USA;1. Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA;2. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;1. Global Brain Health Institute, Department of Psychiatry, School of Medicine, Trinity College Dublin, Ireland;2. Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom;3. University of Manchester, Manchester, United Kingdom;4. Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom;5. ENRICH Lead West Midlands NIHR Clinical Research Network (CRN), Birmingham, United Kingdom;6. Bradford District Care NHS Foundation Trust, Bradford, United Kingdom;7. Solent NHS Trust, Portsmouth, United Kingdom;8. Lancashire & South Cumbria NHS Foundation Trust, Preston, United Kingdom;9. Department of Linguistics, Macquarie University, Sydney, Australia;10. Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom |
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| Abstract: | ObjectiveAfter diagnosis of Alzheimer's disease and related syndromes (ADRS), personalized care adapted to each patient's needs is recommended to provide a care plan and start symptomatic treatments according to guidelines. Over the past decade, dedicated structures and care have been implemented in various settings. Equal access to ADRS care, health care providers and services is crucial to ensure potential health benefits for everyone. However, the extent of use of recommended services and favorable health care utilization trajectories (HUT) may vary according to individual and contextual characteristics. The aim of this article was to (1) describe HUT patterns after multidimensional clustering of similar trajectories, (2) assess the proportion of individuals presenting favorable HUTs, and (3) identify factors associated with favorable HUTs.DesignCohort study.Setting and participantsA cohort of 103,317 people newly diagnosed with ADRS identified in the French health reimbursement system (SNDS) was followed for 5 years with their monthly utilization on 11 health care dimensions.MethodsFor 3 age groups (65–74, 75–84, ≥85 years), 15 clusters of patients were identified using partitioning around medoids applied to Levenshtein distances. They were qualitatively assessed by pluridisciplinary experts. Individual and contextual determinants of clusters denoting favorable trajectories were identified using mixed random effects multivariable logistic regression models.ResultsClusters with favorable HUTs denoting slow, progressive trajectories centered on at-home care, represented approximatively 25% of the patients. Determinants of favorable HUTs were mostly individual (age, female gender, absence of certain comorbidities, circumstances of ADRS identification, lower deprivation). Contextual determinants were also identified, in particular accessibility to nurses and nursing homes. Inter-territories variance was small but significant in all age groups (from 0.9% to 1.8%).Conclusion and implicationsFavorable HUTs remain the minority and many efforts can still be made to improve HUTs. Qualitative studies could help understanding underlying barriers to favorable HUTs. |
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| Keywords: | Dementia Alzheimer's disease cohort multidimensional health care utilization trajectory patterns |
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