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The Influence of Primary Care Structural Capabilities on Hospitalizations among Older Adults with Dementia

初级保健结构能力对老年痴呆症患者住院治疗的影响

基本信息

批准号：
10190498
负责人：
Vaneh Elena Hovsepian
金额：
$ 4.82万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-06-15 至 2022-02-28
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10190498
关键词：
Administrative Supplement Administrator Admission activity Affect Age-Years Aging Alzheimer&apos s Disease Alzheimer&apos s disease related dementia American Award Caring Chronic Care Chronic Disease Clinical Communities Community Integration Data Degenerative Disorder Delirium Dementia Drug Prescriptions Elderly Electronic Health Record Funding Gastrointestinal Diseases Health Health Services Healthcare Hospitalization Hospitals Individual Knowledge Length of Stay Linear Regressions Link Medicare Medicare claim Medication Management Mentors Mission Modeling Morbidity - disease rate Myocardial Ischemia National Institute on Aging Nurse Practitioners Nurses Nursing Homes Outcome Patient-Focused Outcomes Patients Physician Assistants Physicians Pneumonia Policy Maker Population Primary Care Physician Primary Health Care Principal Investigator Quality of Care Research Research Personnel Resources Sampling Scientist Structure Surveys System Time United States United States National Institutes of Health beneficiary burden of illness care coordination care delivery care providers cost effective data management disabling disease doctoral student experience falls health care service utilization human old age (65+)improved meetings mortality pre-doctoral primary care setting programs response skills

项目摘要

Currently, 5.8 million Americans have Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD). As the segment of the United States population age 65 and older continues to grow, the number of Americans with AD/ADRD and the use of health care services such as hospitalizations will also increase. Hospitalizations are more prevalent among older adults with AD/ADRD compared to older adults without AD/ADRD. Some of these hospitalizations are considered potentially avoidable if individuals have better access to and quality of primary care. However, delivering high quality primary care is becoming increasingly challenging given the projected shortage of primary care physicians. On the other hand, the number of nurse practitioners (NPs) has grown in the recent years and will increase by 93% by 2025. Further, NPs deliver high- quality and cost-effective care to older adults. Yet, little is known about how to support NPs' ability to deliver high quality care. Particularly, little is known about how to strengthen structural capabilities, essential practice features needed for delivering high quality of care, in practices where NPs provide care to older adults with AD/ADRD. Enhancing primary care delivery through strengthening structural capabilities such as care coordination, the Electronic Health Record (EHR), and community integration in primary care can be an effective potential way to reduce hospitalizations among older adults with AD/ADRD. The overall objective of the proposed study is to assess the effects of primary care structural capabilities in practices employing NPs on both all-cause and potentially avoidable hospitalizations among Medicare beneficiaries with AD/ADRD. This dissertation study will use unique cross-sectional data produced in 2018-2019 from a large National Institutes of Health-funded study and its associated Alzheimer's supplement (PI: Poghosyan, R01 MD011514-03S1). The following specific aims are proposed: Aim 1. Describe structural capabilities (i.e., availability of care coordination, EHR, and community integration) in primary care practices where NPs provide care to Medicare beneficiaries with AD/ADRD. Aim 2. Assess the impact of structural capabilities in primary care practices employing NPs on potentially avoidable and all-cause hospitalizations among Medicare beneficiaries with AD/ADRD. We hypothesize that more structural capabilities will be associated with lower hospitalizations among Medicare beneficiaries with AD/ADRD compared to practices with fewer structural capabilities. Multi- level linear regression models will be used to assess the impact of structural capabilities on hospitalizations among older adults with AD/ADRD. Findings from this study will generate evidence about how structural capabilities may improve primary care delivery for older adults with AD/ADRD. The proposed study is well- aligned with the mission of the National Institute of Aging to identify ways to reduce illness burdens such as hospitalizations among those with AD/ADRD. In addition, this R36 study will allow a pre-doctoral student to develop the skills needed to become an independent health services researcher.

目前，580万美国人患有阿尔茨海默病和阿尔茨海默病相关痴呆症 (AD/ADRD）。随着美国65岁及以上人口的持续增长，美国AD/ADRD患者的数量和医疗保健服务的使用（如住院治疗）也将增加。与未患有AD/ADRD的老年人相比，患有AD/ADRD的老年人住院治疗更为普遍 AD/ADRD。其中一些住院治疗被认为是可以避免的，如果个人有更好的获得初级保健的机会和质量。然而，提供高质量的初级保健正变得越来越重要。由于预计初级保健医生短缺，这一问题具有挑战性。另一方面，护士人数近几年来，执业者（NP）的数量不断增长，到2025年将增长93%。此外，NP提供高- 为老年人提供高质量和高成本效益的护理。然而，人们对如何支持NP的交付能力知之甚少高质量的护理。特别是，人们对如何加强结构能力知之甚少，提供高质量护理所需的功能，在NPs为老年人提供护理的实践中， AD/ADRD。通过加强结构能力，协调，电子健康记录（EHR）和社区整合在初级保健可以是一个减少AD/ADRD老年人住院治疗的有效潜在方法。的总体目标拟议的研究是评估初级保健结构能力在采用NP的实践中的影响所有原因和潜在可避免的住院治疗的医疗保险受益人与AD/ADRD。这论文研究将使用2018-2019年从大型国立研究所获得的独特横截面数据健康资助的研究及其相关的阿尔茨海默氏症补充剂（PI：Poghosyan，R 01 MD 011514 - 03 S1）。提出了以下具体目标：目标1。描述结构能力（即，提供护理协调，EHR和社区整合）在初级保健实践中，NP向Medicare提供护理 AD/ADRD患者。目标2.评估初级保健实践中结构能力的影响在医疗保险受益人中， AD/ADRD。我们假设更多的结构能力将与较低的住院率相关与结构能力较低的做法相比，AD/ADRD的医疗保险受益人。多重水平线性回归模型将用于评估结构能力对住院的影响老年AD/ADRD患者中。这项研究的结果将产生关于结构如何能力可以改善AD/ADRD老年人的初级保健服务。这项研究是很好的- 与国家老龄化研究所的使命保持一致，以确定减少疾病负担的方法，如 AD/ADRD患者的住院率。此外，这项R36研究将允许博士预科生发展成为独立的卫生服务研究人员所需的技能。