Accountable Care for Persons with Advanced Dementia

对晚期痴呆症患者的负责任的护理

• 批准号: 10228604
• 负责人: PEDRO L GOZALO
• 金额: $ 20.51万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-15 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10228604
• 关键词: Address; Affect; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease related dementia; American; Americas; Caring; Cause of Death; Cessation of life; Characteristics; Clinical; Clinical Data; Communication; Data; Data Set; Dementia; Disease; Dyspnea; Elderly; Enrollment; Enteral Feeding; Family; Fee-for-Service Plans; Financial compensation; Future; Goals; Growth; Health Personnel; Health Policy; Health Services Research; Healthcare; Home; Home Nursing Care; Hospitalization; Hospitals; Incentives; Infrastructure; Institutionalization; Insurance Carriers; Intervention; Knowledge; Life; Link; Mechanical ventilation; Medical; Medicare; Medicare claim; Methodology; Methods; Nerve Degeneration; Nursing Homes; Observational Study; Outcome; Pain; Palliative Care; Patient Care; Patient Rights; Patients; Persons; Physicians; Policies; Population; Privatization; Prognosis; Program Research Project Grants; Prospective cohort; Public Policy; Quality of Care; Race; Research; Retrospective cohort; Risk; Role; Shapes; System; Time; Training; Treatment outcome; Visit; Vulnerable Populations; Work; advanced dementia; base; beneficiary; care coordination; care costs; care delivery; care fragmentation; care outcomes; care preference; care providers; cohort; comorbidity; cost; data infrastructure; data resource; decubitus ulcer; demographics; end of life; end of life care; experience; functional status; health care delivery; hospice environment; hospitalization rates; improved; individual patient; novel; nursing home length of stay; older patient; payment; population based; preference; programs

Project Summary An important public policy challenge is how to provide patient- and family-centered care for an increasing number of Americans afflicted with Alzheimer’s Disease and Related Dementias (ADRD). The proposed research team has documented that, despite family preferences for care that maximize comfort, patients too often receive burdensome treatments and unnecessary health care transitions in the last days of life. In part, volume-based compensation incentivizes multiple transitions and the fragmentation of care experienced by people with ADRD. This contributes to care of limited value that is potentially inconsistent with patients’ prior stated wishes or the informed preferences of their family. Accountable Care Organizations (ACOs) are one of the largest recent changes in Medicare payment and reforms in health care delivery. An ACO is a group of health care providers responsible for quality and cost of a defined population based on the preponderance of visits to a primary care provider. Through enhanced care coordination and improved communication between health care providers and families about prognosis and goals of care, ACOs have the potential to improve care during the last stages of life. Preliminary research conducted at a single ACO with a home-based palliative care program found reduced hospitalization and delayed institutionalization in persons considered high-need, high-cost. Yet, no study has examined the intersection of ACOs and the care of persons with advanced ADRD. The overriding objective of this proposal is to further our understanding of how the relatively new ACO approach to care delivery impacts the experience and outcomes of vulnerable older persons with advanced dementia by addressing the three following questions: 1) To what extent are advanced ADRD patients integrated in ACOs? (Aim 1); 2) Do ACOs improve end-of-life care outcomes for advanced ADRD patients? (Aim 2); and 3) Which ACO characteristics are associated with better care of advanced ADRD patients? (Aim 3). We will leverage our team’s extensive content and methodological expertise to use MDS assessments to identify persons with advanced ADRD that either had a nursing home (NH) stay post-hospitalization or resided in a NH, as well as the Program Project Grant infrastructure of linked national datasets (Minimum Data Set, Medicare Claims data) to address these key health policy issues in the intersecting fields of palliative care, dementia, and health services research. Our proposed research will be the first national study of the role and impact of ACOs in the care of persons with advanced ADRD. Furthermore, it will capitalize on rich clinical data from MDS assessments to create prospective and retrospective cohorts of persons with advanced ADRD, employ novel cross-temporal propensity matching methods, and examine the growth of ACOs, enhancing our ability to draw causal inferences from an observational study. Knowledge gained from this research will provide important answers about the role of ACOs in the care of persons with advanced dementia with the ultimate goal of delivering high-value care that respects patients’ rights to make choices about their medical care.

项目摘要 一个重要的公共政策挑战是如何为日益增加的病人和家庭提供以病人和家庭为中心的护理。 患有阿尔茨海默病和相关痴呆症（ADRD）的美国人的数量。拟议 一个研究小组已经证明，尽管家庭偏好最大限度地舒适的护理， 在生命的最后几天经常接受繁重的治疗和不必要的医疗保健过渡。在某种程度上， 基于量的补偿激励多个过渡和护理的碎片化， ADRD患者。这有助于有限价值的护理，这可能与患者先前的期望不一致。 表达的意愿或其家人的知情偏好。问责护理组织（ACO）是一个 最近最大的医疗保险支付和医疗保健提供改革的变化。ACO是一组 卫生保健提供者负责质量和成本的一个确定的人口基础上的优势， 访问初级保健提供者。通过加强护理协调和改善 医疗保健提供者和家庭关于预后和护理目标，ACO有潜力改善护理 在生命的最后阶段。在一个ACO进行的初步研究，使用基于家庭的姑息疗法 护理计划发现，被认为有高需求的人的住院率减少并推迟了住院治疗， 高成本。然而，还没有研究检查ACO和晚期ADRD患者护理的交叉点。 这项建议的首要目的，是让我们进一步了解相对较新的《建筑物条例》 提供护理的方法影响到有高级护理服务的弱势老年人的经验和成果 通过解决以下三个问题来研究痴呆：1）晚期ADRD患者在多大程度上 在ACO？(Aim 1）; 2）ACO是否改善晚期ADRD患者的临终关怀结局？ (Aim 2）; 3）ACO的哪些特征与晚期ADRD患者的更好护理相关？（目标 3）。我们将利用我们团队广泛的内容和方法专业知识，使用MDS评估， 识别住院后入住疗养院（NH）或居住在 在NH，以及链接的国家数据集的计划项目赠款基础设施（最小数据集， 医疗保险索赔数据）来解决姑息治疗交叉领域的这些关键卫生政策问题， 痴呆症和健康服务研究。我们提出的研究将是第一个国家研究的作用， ACO在晚期ADRD患者护理中的影响。此外，它将利用丰富的临床数据 从MDS评估中创建晚期ADRD患者的前瞻性和回顾性队列， 采用新的跨时间倾向匹配方法，并检查ACO的增长，提高我们的 从观察性研究中得出因果推论的能力。从这项研究中获得的知识将提供 关于ACO在晚期痴呆症患者护理中的作用的重要答案， 我们的目标是提供高价值的护理，尊重患者对医疗护理做出选择的权利。