Assessing Diagnosis and Treatment Delays and Health Care Disparities by Race/Ethnicity among Individuals with Alzheimer’s Disease and Related Dementias

项目总结/摘要 阿尔茨海默病和相关痴呆症（ADRD）的早期发现和管理对于 提高患者的治疗效果，最大限度地提高患者和护理人员的生活质量， 护理利用率有证据表明，非洲裔美国人和西班牙裔可能会经历ADRD诊断， 和治疗延迟，尽管他们的患病率高于白人。更好地针对ADRD护理 种族和族裔群体的改善工作取决于对诊断和 治疗延迟，导致的健康结果，以及这些人群的护理利用模式。 本申请调查了ADRD诊断和管理中的种族和民族差异， 疾病的早期至生命末期。我们将利用调查数据进行独特的认知测量 健康与退休调查（HRS）和老龄化，人口统计学和记忆研究 （亚当斯），与Medicare和Medicaid索赔文件相关联。HRS是一项持续的美国全国性调查。 50岁以上的成年人，代表社区住宅和养老院居民。HRS面试 每两年约有20，000名受访者，对非洲裔美国人和西班牙裔美国人进行了过度抽样。使用此 数据库，该数据库将索赔数据与具有独特认知功能测量的基于人口的调查相关联， 评估ADRD的严重程度，我们的研究可以解决先前研究的局限性，以实现以下目标： 目的1：按人种/种族描述ADRD诊断延迟，调整疾病严重程度 假设1.1：患有早期ADRD的非洲裔美国人和西班牙裔美国人比白人更不可能接受治疗。 在Medicare或Medicaid索赔中的ADRD编码诊断 假设1.2：非裔美国人和西班牙裔美国人在诊断时比白人有更晚期的ADRD 目的2：按人种/种族描述ADRD治疗延迟和停药的特征，并根据疾病进行调整 严重程度 假设2.1：非洲裔美国人和西班牙裔美国人比白人更不可能接受抗痴呆治疗 首次诊断后的药物治疗 假设2.2：非洲裔美国人和西班牙裔美国人比白人更有可能停止抗痴呆症治疗 初步诊断后的药物治疗 目标3：描述ADRD医疗保健费用和临终关怀方面的种族和民族差异， 根据疾病严重程度进行调整 假设3.1：患有ADRD的非洲裔美国人和西班牙裔美国人有更多潜在可避免的住院治疗， 更多的30天计划外再入院，以及比白人更高的医疗保健费用 假设3.2：患有ADRD的非洲裔美国人和西班牙裔美国人对临终关怀的使用率较低， 在生命结束时的干预措施，以及比白人更高的生命结束成本 1

Project Summary/Abstract Early detection and management of Alzheimer's Disease and Related Dementias (ADRD) is crucial to promoting patient outcomes, maximizing quality of life for both the patient and caregiver, and optimizing health care utilization. Evidence suggests that African Americans and Hispanics may experience ADRD diagnosis and treatment delays despite having a higher disease prevalence than whites. Better targeting of ADRD care improvement efforts across racial and ethnic groups depends on robust assessment of diagnosis and treatment delays, resulting health outcomes, and care utilization patterns in these populations. This application investigates racial and ethnic disparities in ADRD diagnosis and management, from the early to end-of-life stages of the disease. We will leverage survey data with unique measures of cognitive function from the Health and Retirement Survey (HRS) and the Aging, Demographics and Memory Study (ADAMS), linked with Medicare and Medicaid claims files. The HRS is a continuous, national survey of U.S. adults over age 50 representative of community-dwelling and nursing home residents. The HRS interviews ~20,000 respondents every two years, with oversampling of African Americans and Hispanics. Using this database, which links claims data to a population-based survey with unique cognitive functioning measures to assess ADRD severity, our study can address limitations of prior research to achieve the following aims: Aim 1: Characterize ADRD diagnosis delay by race/ethnicity, adjusting for disease severity Hypothesis 1.1: African Americans and Hispanics with early ADRD are less likely than whites to receive a coded diagnosis of ADRD on their Medicare or Medicaid claims Hypothesis 1.2: African Americans and Hispanics have more advanced ADRD at diagnosis than whites Aim 2: Characterize ADRD treatment delay and discontinuation by race/ethnicity, adjusting for disease severity Hypothesis 2.1: African Americans and Hispanics are less likely than whites to be treated with anti-dementia medications following initial diagnosis Hypothesis 2.2: African Americans and Hispanics are more likely than whites to discontinue anti-dementia medication therapy following initial diagnosis Aim 3: Characterize racial and ethnic disparities in ADRD health care costs and end-of-life care, adjusting for disease severity Hypothesis 3.1: African Americans and Hispanics with ADRD have more potentially avoidable hospitalizations, more unplanned 30-day readmissions, and higher health care costs than whites Hypothesis 3.2: African-Americans and Hispanics with ADRD have lower hospice use, more burdensome interventions at the end of life, and higher end-of-life costs than whites 1