title: Health Care Service Utilization of Dementia Patients before and after Institutionalization: A Claims Data Analysis.
abstract: BACKGROUND
  Community-based and institutional dementia care has been compared in cross-sectional studies, but longitudinal information on the effect of institutionalization on health care service utilization is sparse.
  
  
  METHODS
  We analyzed claims data from 651 dementia patients via Generalized Estimation Equations to assess health care service utilization profiles and corresponding expenditures from four quarters before to four quarters after institutionalization.
  
  
  RESULTS
  In all domains, utilization increased in the quarter of institutionalization. Afterwards, the use of drugs, medical aids, and non-physician services (e.g., occupational therapy and physiotherapy) remained elevated, but use of in- and outpatient treatment decreased. Cost of care showed corresponding profiles.
  
  
  CONCLUSIONS
  Institutional dementia care seems to be associated with an increased demand for supportive services but not necessarily for specialized medical care.
authors.affiliation: Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Larissa
authors.initials: L
authors.lastname: Schwarzkopf
authors.affiliation: Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Yi
authors.initials: Y
authors.lastname: Hao
authors.affiliation: Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Neuherberg, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
authors.affiliation: Department of Medical Psychology and Medical Sociology, Alexander-Universität Erlangen-Nürnberg, Clinic for Psychiatry and Psychotherapy, Erlangen, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Graessel
keywords: Administrative data; Costs; Generalized estimation equation; Longitudinal analysis; Nursing home placement; Payer perspective; Profile; Statutory health insurance; Trend