Racial/Ethnic Disparities in Home Health Care for Persons with Alzheimer’s Disease and Related Dementias

阿尔茨海默病和相关痴呆症患者家庭保健中的种族/民族差异

• 批准号: 10302427
• 负责人: Chenjuan Ma
• 金额: $ 13.23万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10302427
• 关键词: Address; Admission activity; Affect; African American; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Area; Asian Americans; Asians; Caring; Characteristics; Clinical; Communities; Complex; Data; Data Set; Dementia; Development; Diagnosis; Effectiveness; Elderly; Enrollment; Environmental Risk Factor; Family; Future; Geographic Locations; Geography; Goals; Government; Growth; Health; Health Policy; Health Resources; High Prevalence; Hispanic Americans; Hispanics; Home; Home Care Services; Home Health Agency; Home Health Aides; Hospital Nursing; Incentives; Individual; Knowledge; Link; Medicare; Medicare claim; Methods; Minority; Modeling; Native Americans; Not Hispanic or Latino; Nursing Homes; Outcome; Persons; Play; Policies; Population; Population Heterogeneity; Primary Nursing Care; Public Health; Quality of Care; Recovery; Registered nurse; Research; Resources; Role; Sampling; Sampling Studies; Self Care; Service delivery model; Site; Source; Symptoms; Time; Vulnerable Populations; Workforce Development; aging in place; aging population; base; beneficiary; care outcomes; care recipients; clinical practice; community based service; dementia care; disparity reduction; ethnic difference; ethnic diversity; ethnic minority population; experience; health care availability; health care quality; health care settings; health disparity; health practice; high risk; hospital readmission; improved; improved outcome; innovation; interest; power analysis; preference; racial and ethnic; racial and ethnic disparities; rapid growth; social; sociodemographics; trend

Abstract Alzheimer’s disease and related dementias (ADRD) affect 5.8 million Americans and disproportionately impact racial/ethnic minorities. Despite their complex health and social needs, the majority of persons with ADRD live at home and prefer to do so for as long as possible. Consequently, there is a rapid growth in the demand for home health care (HHC), a leading form of home- and community-based services (HCBS) to support this vulnerable population. The need for HHC is further intensified among racial/ethnic minorities as research has shown that they had higher prevalence of ADRD and more severe symptoms of dementia but limited financial resources for institutional care. At the same time, research from care settings other than HHC has indicated that minorities such as Blacks and Hispanics are less likely to receiving care from high-quality facilities and are more likely to have worse outcomes (e.g., rehospitalization and poor function). However, it is unclear whether similar differences exist among persons with ADRD in the HHC setting. It is also unknown is whether such racial/ethnic differences are affected by health policies (i.e., home health value-based purchase model, HHVBP) aiming at improving quality and efficiency of HHC and the availability of HHC resources, nor how much of the differences can be explained by individual characteristics. We therefore propose a project to elucidate racial/ethnic disparities in quality of HHC among persons with ADRD. This study has two specific Aims: Aim 1) To examine admission to high-quality home health agencies among racial/ethnic minority HHC recipients with ADRD (i.e., non-Hispanic Blacks, Hispanics, Asians, and Native Americans), compared to their White counterparts. We hypothesize (1) racial/ethnic minorities with ADRD are less likely to be admitted to high-quality agencies than their White counterparts, and (2) such differences are smaller in areas with HHVBP model and larger in areas with less HHC resources; and Aim 2) To determine quality outcomes of racial/ethnic minorities with ADRD during HHC, comparing to their White counterparts. We hypothesize that racial/ethnic minorities with ADRD experience poorer outcomes, including higher risk of rehospitalization and less improvement in function during HHC, than their White counterparts. We will also explore how much of these racial/ethnic differences can be explained by individual and environmental factors. This study is innovative because it is the first to creatively link multiple national datasets and use Blinder-Oaxaca method to elucidate racial/ethnic disparities in the quality of HHC among persons with ADRD. This research is significant as it addresses a growing public health concern regarding the quality and equity of care for this vulnerable population. Findings from this study will enrich our knowledge regarding home- and community-based services to racial/ethnic minorities with ADRD. The findings will inform future efforts aiming at reducing health disparities and improving quality and outcomes of dementia care in the HHC setting. It has immediate implications for health policy and practice.

摘要 阿尔茨海默病和相关痴呆症(ADRD)影响着580万美国人，对 少数族裔。尽管他们的健康和社会需求复杂，但大多数ADRD患者生活在 在家里，而且更愿意尽可能长时间地这样做。因此，对…的需求迅速增长 家庭保健(HHC)，这是一种以家庭和社区为基础的服务(HCBS)的领先形式 弱势群体。根据研究，在种族/少数民族中，对HHC的需求进一步加剧 显示他们有更高的ADRD患病率和更严重的痴呆症症状，但经济有限 用于机构护理的资源。与此同时，来自HHC以外的护理机构的研究表明 少数族裔，如黑人和西班牙裔，不太可能从高质量的设施中接受护理，而更多的是 可能有更差的结果(例如，再次住院和功能不佳)。然而，目前还不清楚类似的 在HHC设置中，ADRD患者之间存在差异。同样未知的是，这种种族/民族 差异受健康政策(即基于家庭健康价值的购买模式，HHVBP)的影响 提高HHC的质量和效率以及HHC资源的可用性，或者差异有多大 可以用个体特征来解释。因此，我们提出一个项目，以澄清种族/民族 ADRD患者在HHC质量上的差异。这项研究有两个具体目的：目的1)检查 患有ADRD的种族/少数民族HHC接受者进入高质量的家庭健康机构(即， 非西班牙裔黑人、西班牙裔、亚洲人和美洲原住民)，与他们的白人同行相比。我们 假设(1)患有ADRD的种族/少数民族不太可能被高质量的机构录取 (2)这种差异在有HHVBP模型的地区较小，在地区较大 用较少的卫生和人力资源；和目标2)确定患有ADRD的种族/族裔少数群体在 HHC，与他们的白人同行相比。我们假设有ADRD经历的种族/少数民族 与HHC相比，结果更差，包括再次住院的风险更高，功能改善更少 他们的白人同行。我们还将探索这些种族/民族差异在多大程度上可以用 个人和环境因素。这项研究具有创新性，因为它是第一次创造性地将 国家数据集，并使用Blinder-Oaxaca方法阐明HHC质量的种族/民族差异 在患有ADRD的人中。这项研究具有重要意义，因为它解决了日益增长的公共卫生问题 关于这一弱势群体的护理质量和公平性。这项研究的发现将丰富我们的 了解向患有ADRD的种族/族裔少数群体提供家庭和社区服务的情况。调查结果 将为未来旨在缩小健康差距和改善痴呆症质量和结果的努力提供信息 在HHC环境中进行护理。它对卫生政策和实践有直接影响。