Potential New Barriers to Home Health Access for People with Alzheimer's Disease and Related Dementias

项目总结/摘要 应聘者：我是健康学院物理治疗系的助理教授 在南卡罗来纳州查尔斯顿的南卡罗来纳州医科大学实习。我的长期目标是 成为一个资金充足，独立的研究人员调查后急性护理的个人与阿尔茨海默氏症 疾病及相关痴呆（ADRD）。为了实现这一目标，我将利用我的临床专业知识， 目前的研究训练。对于K 01阶段，我设定了四个短期培训目标：（1）培养 在影响ADRD患者的急性期后护理政策方面的能力，（2）发展管理技能， ADRD患者的医疗保险数据的操作，（3）发展倾向评分方法的能力 和数据分析的人与ADRD的数据，和（4）提高我的granitarian，道德行为， 研究和指导技能，促进职业发展和进步。 导师团队：我的主要导师是Kit Simpson，DrPH，我的共同导师是Kenneth Ottenbacher，PhD， OTR。指导团队的其他成员包括安妮辛普森博士，雅各布明策，医学博士，工商管理硕士， Kathryn H Bowles博士，注册护士，FAAN，FACMI。我的指导团队是高素质的，包括全国和 国际公认的卫生服务研究专家（K。Simpson），急性期后护理质量措施 （K. Ottenbacher），ADRD（J. Mintzer），观察性研究的研究设计和分析方法（A. 辛普森），家庭健康实践，政策和研究（K。Bowles）。我的指导团队将指导我的职业生涯 开发活动，并参与K 01研究。 研究策略：受COVID-19影响，2020年Medicare家庭健康经历了前所未有的变化 流行病和新的支付模式。这些巨大的变化可能会加剧现有的国内壁垒 为ADRD患者提供健康服务。减少获得家庭健康对ADRD患者造成伤害 并可能引发对卫生保健系统的一系列资源和财政影响。影响的 目前ADRD患者的家庭健康获取和质量危机尚未得到审查，但迫切需要 needed.本K 01项目将使用匹配良好的组，以显示报销变更的影响， 通过分析，大流行对ADRD患者和非ADRD患者的家庭健康获取和结局的破坏 医疗保险评估和账单数据。倾向评分方法将用于平衡患者风险因素 对于对照组。目标1：描述健康和非健康人群在家庭健康可及性和结果方面的差异。 匹配2019年有和没有ADRD的医疗保险受益人（MB）组。目标2：审查 2019年与2020年匹配良好的MB组的家庭健康获取和结果。目标3：审查变化 在家庭健康的访问和结果匹配组的MB在2019年与2021年。时发现的问题 这项研究可以帮助ADRD患者和医疗保险系统优化获得、成本和结果， 告知宣传工作、当前家庭健康实践和未来急性期后护理政策。

PROJECT SUMMARY/ABSTRACT Candidate: I am an assistant professor in the Division of Physical Therapy in the College of Health Professions at the Medical University of South Carolina in Charleston, South Carolina. My long-term goal is to become a well-funded, independent researcher investigating post-acute care of individuals with Alzheimer’s Disease and Related Dementias (ADRD). To achieve this goal, I will build upon my clinical expertise and current research training. For the K01 period, I have set four short term training goals/objectives: (1) Develop competence in post-acute care policy impacting people with ADRD, (2) Develop skills in management and manipulation of Medicare data of people with ADRD, (3) Develop competence in propensity score methods and data analysis for data of people with ADRD, and (4) Enhance my grantsmanship, ethical conduct of research, and mentorship skills for career development and advancement. Mentoring Team: My Primary Mentor is Kit Simpson, DrPH and my Co-Mentor is Kenneth Ottenbacher, PhD, OTR. Additional members of the mentoring team include Annie Simpson PhD, Jacobo Mintzer, MD, MBA, and Kathryn H Bowles PhD, RN, FAAN, FACMI. My mentoring team is highly qualified and includes nationally and internationally recognized experts in health services research (K. Simpson), post-acute care quality measures (K. Ottenbacher), ADRD (J. Mintzer), study design and analysis methods for observational studies (A. Simpson), and home health practice, policy, and research (K. Bowles). My mentoring team will guide career development activities and participate in the K01 research. Research Strategy: Medicare home health underwent unprecedented changes in 2020 due to the COVID-19 pandemic and a new payment model. These vast changes threaten to exacerbate existing barriers to home health access for people with ADRD. Decreased access to home health causes harm to people with ADRD and can trigger a cascade of resource and financial implications for the health care system. Impacts of the current crisis on home health access and quality for people with ADRD has not been examined but is urgently needed. This K01 project will use well matched groups, to show the impact of reimbursement change and pandemic disruption on home health access and outcomes for people with and without ADRD through analysis of Medicare assessment and billing data. Propensity score methods will be used to balance patient risk factors for comparison groups. Aim 1: Describe differences in home health access and outcomes between well- matched groups of Medicare Beneficiaries (MBs) with and without ADRD in 2019. Aim 2: Examine changes in home health access and outcomes for well-matched groups of MBs in 2019 vs 2020. Aim 3: Examine changes in home health access and outcomes for well-matched groups of MBs in 2019 vs 2021. Findings from this study can help to optimize access, cost, and outcomes for people with ADRD and the Medicare system and inform advocacy efforts, current home health practice, and future post-acute care policies.