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Enhanced Quality in Primary Care for Elders with Diabetes and Dementia (EQUIPED-ADRD)

提高患有糖尿病和痴呆症的老年人的初级保健质量 (EQUIPED-ADRD)

基本信息

批准号：
10163761
负责人：
JOSHUA CHODOSH
金额：
$ 79.7万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-30 至 2023-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10163761
关键词：
Adverse event Affect Age Alzheimer&apos s disease related dementia American Blood Pressure Cardiovascular Diseases Caregiver Burden Caregivers Caring Chronic Chronic Disease Clinic Clinical Clinical Trials Complex Computerized Medical Record Confusion Consensus Data Decision Making Dementia Development Diabetes Mellitus Diagnosis Disease Elderly Electronic Health Record Ethnic Origin Evaluation Methodology Family Family Caregiver Feedback Friends Goals Guidelines Health Priorities Health Status Health system Healthcare Systems Heterogeneity Hospitals Hypertension Hypoglycemia Impaired cognition Intervention Interview Lead Learning Life Expectancy Link Logistics Long-Term Care for Elderly Medical Medicare/Medicaid Methods Microvascular Dysfunction Outcome Patients Phase Phased Innovation Awards Prevalence Primary Health Care Process Provider Quality of Care Quality of life Race Randomized Randomized Controlled Trials Reporting Research Resources Risk Self Management Severities Site Stress Surveys Symptoms System Testing Uncertainty acute care base blood pressure regulation care providers clinical practice comorbidity cost design diabetes management diabetic diabetic patient electronic data feasibility testing health care service hospital utilization improved insurance claims medical complication medical specialties older patient payment pragmatic trial preference programs skills trial design

项目摘要

Over 11 million Americans who are ≥65 years have Diabetes (DM), a prototypic chronic disease requiring self-management. Up to 30% of older adults have co-occurring DM and Alzheimer’s disease and related dementia (ADRD) and older people with DM may have as much as a two-fold risk of developing ADRD. Caregivers of patients with co-occurring DM-ADRD have many unmet needs, adversely affecting caregivers’ ability to manage these conditions. Moreover, a lack evidence for what constitutes optimal DM management for these patients, particularly those of more advanced age (≥ 75 years), further compounds the challenge of managing this chronic and often comorbid disease from both the patient and medical provider perspective. With a lack of decisional guidance, primary care providers are currently ill equipped to direct care to achieve best outcomes. The goal of this research is to develop and test a quality improvement program for older patients with DMADRD, using a pragmatic randomized controlled trial (RCT) and mixed methods in a large, diverse healthcare system. This will feature consensus decisional guidance for the medical management of DM-ADRD patients, PCP workflow enhancements including use of a panel manager and the electronic health record (EHR) for decision support/feedback, and PCP collaborative learning. To conduct this study, “Enhanced Quality In Primary care for Elders with Diabetes-ADRD” (EQUIPED-ADRD), we will use the R21/R33 mechanism. The R21 in the first year will develop key resources needed for the pragmatic trial, such as provider decisional guidance based on current evidence, trial design and evaluation methodology, appropriate healthcare system administrative / EHR support, and will test intervention feasibility. The R33 will implement the larger pragmatic trial in a large healthcare system through cluster randomization of the 12 largest primary care practice sites with ~60 providers and over 600 patients with diagnosed DM and ADRD. It will test hypotheses about whether care based on explicit standards for DM medical management for people with ADRD will: H1) Improve patient symptoms and quality of life while maintaining expected clinical outcomes; H2) decrease patient and caregiver management burden and improve care quality based on patient/caregiver preferences; H3) (secondary) decrease specialty, ED and hospital utilization. We will gather data from the EHR, Medicare and Medicaid insurance claims, caregiver surveys and qualitative interviews, and clinician interviews. If this clinical trial demonstrates that patients and family caregivers who receive this enhanced care quality program achieve established goals for diabetic care in addition to fewer dementia-related symptoms, less caregiver burden and stress, and fewer DM-related adverse events, potentially avoidable and costly utilization may also decrease. This best practice approach could then be widely disseminated to other clinical practices.

超过1100万65岁以上的美国人患有糖尿病（DM），这是一种需要自我管理的典型慢性疾病。

项目成果

期刊论文数量（2）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Barriers to Vaccination Among People with Parkinson's Disease and Implications for COVID-19.

DOI：
10.3233/jpd-202497
发表时间：
2021
期刊：
Journal of Parkinson's disease
影响因子：
0
作者：
Phanhdone T;Drummond P;Meisel T;Friede N;Di Rocco A;Chodosh J;Fleisher J
通讯作者：
Fleisher J

Perceptions of Treatment Burden Among Caregivers of Elders With Diabetes and Co-morbid Alzheimer's Disease and Related Dementias: A Qualitative Study.

患有糖尿病和共病阿尔茨海默病及相关痴呆症的老年人的护理人员对治疗负担的看法：一项定性研究。

DOI：
10.1177/10547738211067880
发表时间：
2023
期刊：
Clinical nursing research
影响因子：
1.7
作者：
VaughanDickson,Victoria;Melnyk,Halia;Ferris,Rosie;Leon,Alejandra;Arcila-Mesa,Mauricio;Rapozo,Crystalinda;Chodosh,Joshua;Blaum,CarolineS
通讯作者：
Blaum,CarolineS