The ACTIVE cognitive training trial and predicted medical expenditures

Fredric D Wolinsky, Henry W Mahncke, Mark Kosinski, Frederick W Unverzagt, David M Smith, Richard N Jones, Anne Stoddard, Sharon L Tennstedt, Fredric D Wolinsky, Henry W Mahncke, Mark Kosinski, Frederick W Unverzagt, David M Smith, Richard N Jones, Anne Stoddard, Sharon L Tennstedt

Abstract

Background: Health care expenditures for older adults are disproportionately high and increasing at both the individual and population levels. We evaluated the effects of the three cognitive training interventions (memory, reasoning, or speed of processing) in the ACTIVE study on changes in predicted medical care expenditures.

Methods: ACTIVE was a multisite randomized controlled trial of older adults (>or= 65). Five-year follow-up data were available for 1,804 of the 2,802 participants. Propensity score weighting was used to adjust for potential attrition bias. Changes in predicted annualmedical expenditures were calculated at the first and fifth annual follow-up assessments using a new method for translating functional status scores. Multiple linear regression methods were used in this cost-offset analysis.

Results: At one and five years post-training, annual predicted expenditures declinedby $223 (p = .024) and $128 (p = .309), respectively, in the speed of processing treatment group, but there were no statistically significant changes in the memory or reasoning treatment groups compared to the no-contact control group at either period. Statistical adjustment for age, race, education, MMSE scores, ADL and IADL performance scores, EPT scores, chronic condition counts, and the SF-36 PCS and MCS scores at baseline did not alter the one-year ($244; p = .012) or five-year ($143; p = .250) expenditure declines in the speed of processing treatment group.

Conclusion: The speed of processing intervention significantly reduced subsequent annual predicted medical care expenditures at the one-year post-baseline comparison, but annual savings were no longer statistically significant at the five-year post-baseline comparison.

References

    1. Lee R, Miller T. An approach to forecasting health expenditures, with application to the U.S. Medicare system. Health Serv Res. 2002;37:1365–1386. doi: 10.1111/1475-6773.01112.
    1. Heffler S, Smith S, Keehan S, Clemens MK, Zezza M, Truffer C. Health spending projections through 2013. Health Aff. 2004;W4:79–93.
    1. Wolinsky FD, Johnson RJ. The use of health services by older adults. J Gerontol: Soc Sci. 1991;46:S345–S357.
    1. Fitzgerald JF, Smith DM, Martin DK, Freedman JN, Wolinsky FD. Replication of the multidimensionality of activities of daily living. J Gerontol: Soc Sci. 1993;48:S28–S31.
    1. Stump TE, Clark DO, Johnson RJ, Wolinsky FD. The structure of health status among Hispanic, African-American, and White older adults. J Gerontol: Soc Sci. 1997;52:49–60.
    1. Clark DO, Stump TE, Wolinsky FD. A race- and gender-specific replication of five dimensions of functional limitation and disability. J Aging Health. 1997;9:28–42. doi: 10.1177/089826439700900102.
    1. Johnson RJ, Wolinsky FD. The structure of health status among older adults: A model of disease, disability, limitations, and perceived health. J Health Soc Behav. 1993;34:105–121. doi: 10.2307/2137238.
    1. Stump TE, Johnson RJ, Wolinsky FD. Changes in physician utilization by older adults over time. J Gerontol: Soc Sci. 1995;50:S45–S58.
    1. Wolinsky FD, Culler SD, Callahan CM, Johnson RJ. Hospital resource consumption among older adults: A prospective analysis of episodes, length of stay, and charges over a seven-year period. J Gerontol: Soc Sci. 1994;49:S240–S252.
    1. Wolinsky FD, Stump TE, Johnson RJ. Hospital utilization profiles among older adults over time: Consistency and volume among survivors and decedents. J Gerontol: Soc Sci. 1995;50:S88–S100.
    1. Perls TT, Wood ER. Acute care costs of the oldest old. They cost less, their care intensity is less, and they go to non-teaching hospitals. Arch Intern Med. 1996;156:754–760. doi: 10.1001/archinte.156.7.754.
    1. Taylor DH, Sloan FA. How much do persons with Alzheimer's Disease cost Medicare. J Am Geriatr Soc. 2000;48:639–646.
    1. Taylor DH, Schenkman M, Zhou J, Sloan FA. The relative effect of Alzheimer's disease and related dementias, disability, and comorbidities on cost of care for elderly persons. J Gerontol: Soc Sci. 2001;56B:S285–S293.
    1. Walsh EG, Wu B, Mitchell JB, Berkman LF. Cognitive function and acute care utilization. J Gerontol: Soc Sci. 2003;58B:S38–S49.
    1. Jobe JB, Smith DM, Ball K, Tennstedt SL, Marsiske M, Willis SL, Rebok GW, Morris JN, Helmers KF, Leveck MD, Kleinman K. ACTIVE: a cognitive intervention trial to promote independence in older adults. Controlled Clin Trials. 2001;22:453–479. doi: 10.1016/S0197-2456(01)00139-8.
    1. Ball D, Berch DB, Helmers KF, Jobe JB, Leveck MD, Marsiske M, Morris JN, Rebok GW, Smith DM, Tennstedt SL, Unverzagt FW, Willis SL. Effects of cognitive training interventions with older adults: a randomized controlled trial. JAMA. 2002;288:2271–2281. doi: 10.1001/jama.288.18.2271.
    1. Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, Morris JN, Rebok GW, Unverzagt FW, Stoddard AM, Wright E. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA. 2006;296:2805–2814. doi: 10.1001/jama.296.23.2805.
    1. Wolinsky FD, Unverzagt FW, Smith DM, Jones R, Wright E, Tennstedt S. The effects of the ACTIVE cognitive training interventions on clinically relevant declines in health-related quality of life. J Gerontol: Soc Sci. 2006;61B:S281–S287.
    1. Wolinsky FD, Unverzagt FW, Smith DM, Jones R, Stoddard A, Tennstedt S. The ACTIVE cognitive training trial and health-related quality of life: Protection that lasts for five years. J Gerontol: Med Sci. 2006;61A:1324–1329.
    1. Wolinsky FD, Weg MW Vander, Martin R, Unverzagt FW, Ball K, Jones R, Tennstedt SL. The effect of speed of processing training on depressive symptoms in ACTIVE. J Gerontol: Med Sci. 2009;64A:68–472.
    1. Wolinsky FD, Mahncke HW, Weg MW Vander, Martin R, Unverzagt FW, Ball KK, Jones R, Tennstedt SL. The ACTIVE cognitive training interventions and the onset of and recovery from suspected clinical depression. J Gerontol Psych Sci.
    1. Fleishman JA, Cohen JW, Manning WG, Kosinski M. Using the SF-12 health status measure to improve predictions of medical expenditures. Med Care. 2006;44:54–I. doi: 10.1097/01.mlr.0000208141.02083.86.
    1. Folstein MR, Folstein S, McHugh PR. Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician. J Psych Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Brazier J, Harper R, Jones N. Validating the SF-36 health survey questionnaire: New outcome measure for primary care. BMJ. 1992;305:160–164. doi: 10.1136/bmj.305.6846.160.
    1. McHorney CA, Ware JE, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36). II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993;31:247–263. doi: 10.1097/00005650-199303000-00006.
    1. Stewart AL, Hays RD, Ware JE. The MOS Short-Form General Health Survey: Reliability and validity in a patient population. Med Care. 1988;26:724–736. doi: 10.1097/00005650-198807000-00007.
    1. Tarlov AR, Ware JE, Greenfield S. The Medical Outcomes Study: An application of methods for monitoring the results of medical care. JAMA. 1999;262:925–934. doi: 10.1001/jama.262.7.925.
    1. Ware JE, Kosinski M. The SF-36 physical and mental health summary scales: A manual for user's of version 1. second. Boston: QualityMetric; 1999.
    1. Ware JE, Kosinski M, Dewey JE. How to score version 2 of the SF-36 health survey. Boston: QualityMetric; 2000.
    1. Ware JE. The SF-36 Health Survey. In: Spilker B, editor. Quality of Life and Pharmacoeconomics in Clinical Trials. 2. Philadelphia: Lippincott-Raven Publishers; 1996. pp. 337–345.
    1. Morris J, Morris S. ADL assessment for use with frail elders. J Mental Health Aging. 1997;3:19–45.
    1. Morris JN, Fries BE, Steel K, Ikegami N, Bernabei R, Carpenter GI, Gilgen R, Hirdes JP, Topkinová E. Comprehensive Clinical Assessment in Community Setting: Applicability of the MDS-HC. JAGS. 1997;45:1017–24.
    1. Willis SL. Everyday cognitive competence in elderly persons: conceptual issues and empirical findings. Gerontologist. 1994;36:595–601.
    1. Fillenbaum G. Multidimensional functional assessment of older adults: The Duke Older American Resources and Services Procedures. Hillsdale, N.J.: Erlbaum; 1988.
    1. Rubin DB. Using multivariate matched sampling and regression adjustment to control bias in observational studies. J Amer Stat Assoc. 1979;74:318–324. doi: 10.2307/2286330.
    1. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70:41–55. doi: 10.1093/biomet/70.1.41.
    1. D'Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med. 1998;17:2265–2281. doi: 10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>;2-B.
    1. Centers for Medicare and Medicaid Services Announcement of Calendar Year (CY) 2008 Medicare Advantage Capitation Rates and Payment Policies Baltimore, MD: CMS, April 2, 2007.
    1. Duan N. Smearing estimate: a nonparametric retransformation method. J Amer Stat Ass. 1983;78:605–610. doi: 10.2307/2288126.
    1. Duan N, Li K-C. The Rescaling of a Transformed Outcome Variable and Its Interpretations on a Predictive Scale. Santa Monica, CA: Rand Corporation; 1987.
    1. Cabeza R, Nyberg L. Imaging cognition II: an empirical review of 275 PET and MRI studies. J Cog Neurosci. 2000;12:1–47. doi: 10.1162/08989290051137585.
    1. Salthouse TA. The processing-speed theory of adult age differences in cognition. Psychol Rev. 1996;103:403–428. doi: 10.1037/0033-295X.103.3.403.
    1. Salthouse TA. When does age-related cognitive decline begin? Neurobiol & Aging. 2009;30:507–514. doi: 10.1016/j.neurobiolaging.2008.09.023.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir