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580万美国人， 种族/少数民族。尽管他们有复杂的健康和社会需求，但大多数ADRD患者生活在 在家里，我宁愿尽可能长时间地这样做。因此，对以下方面的需求迅速增长： 家庭保健（HHC），一种主要形式的家庭和社区服务（HCBS），以支持这一点 弱势群体。由于研究表明，少数种族/族裔对HHC的需求进一步加强， 他们有更高的ADRD患病率和更严重的痴呆症状，但经济能力有限， 机构护理资源。与此同时，来自HHC以外的护理机构的研究表明， 黑人和西班牙裔等少数族裔不太可能获得高质量设施的护理，而更多的是 可能具有更差的结果（例如，再住院和功能不良）。目前还不清楚类似的 在HHC环境中，ADRD患者之间存在差异。也不知道这种种族/民族 差异受到卫生政策的影响（即，基于家庭健康价值的购买模式，HHVBP）旨在 提高HHC的质量和效率以及HHC资源的可用性， 可以用个体特征来解释。因此，我们提出一个项目，以阐明种族/族裔 ADRD患者HHC质量的差异。本研究有两个具体目的：目的1）检查 在患有ADRD的种族/少数民族HHC接受者中， 非西班牙裔黑人、西班牙裔、亚洲人和美洲原住民），与他们的白色同行相比。我们 假设（1）患有ADRD的少数种族/民族不太可能被高质量机构录取， 它们的白色对应物，和（2）这种差异在具有HHVBP模型的区域中较小，而在区域中较大 目标2）确定少数种族/族裔ADRD患者在治疗期间的质量结局 HHC，与他们的白色同行相比。我们假设有ADRD经历的少数种族/民族 结果较差，包括HHC期间再住院风险较高和功能改善较少， 他们的白色同伴。我们还将探讨这些种族/民族差异在多大程度上可以用以下因素来解释 个人和环境因素。这项研究是创新的，因为它是第一个创造性地将多个 国家数据集，并使用Blinder-Oaxaca方法阐明HHC质量中的种族/民族差异 在ADRD患者中。这项研究意义重大，因为它解决了日益增长的公共卫生问题 对这一弱势群体的护理质量和公平性。这项研究的结果将丰富我们的 关于向患有ADRD的种族/族裔少数群体提供家庭和社区服务的知识。这些发现 将为未来的努力提供信息，旨在减少健康差距，改善痴呆症的质量和结果 在HHC环境中护理。它对卫生政策和做法有直接影响。