Racial/Ethnic Differences in Palliative Care Services and Potentially Avoidable Hospitalizations at End-of-Life in Nursing Homes Nationwide

全国疗养院临终关怀服务中的种族/民族差异和可避免的住院治疗

• 批准号: 10418632
• 负责人: Leah V Estrada
• 金额: $ 0.51万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10418632
• 关键词: Address; American; Area; Assisted Living Facilities; Attention; Behavioral Model; Black race; COVID-19; COVID-19 impact; Caregivers; Caring; Certification; Cessation of life; Characteristics; Communities; Compassion; Confounding Factors (Epidemiology); County; Cross-Sectional Studies; Data; Data Set; Development; Diagnosis; Elderly; Environment; Ethnic Origin; Family; Fellowship; Fostering; Foundations; Funding; Future; Goals; Health; Health Resources; Health Sciences; Home; Hospitalization; Hospitals; Individual; Knowledge; Latina; Latino; Lead; Life; Link; Low income; Measures; Medicare; Mentors; Mentorship; Methods; National Institute of Nursing Research; National Research Service Awards; Nurses; Nursing Homes; Nursing Students; Older Population; Palliative Care; Palliative Care Nursing; Patients; Population; Provider; Quality of Care; Quality of life; Race; Reporting; Research; Research Methodology; Research Personnel; Research Priority; Research Support; Research Training; Resources; Sampling; Science; Scientist; Surveys; Training; United States; United States National Institutes of Health; Universities; Variant; Vulnerable Populations; Work; aggressive therapy; base; care systems; career; comorbidity; cost; demographics; doctoral student; end of life; end of life care; ethnic difference; ethnic health disparity; ethnic minority; experience; health disparity; health equity; human old age (65+); improved; infection management; multiple data sources; palliative; pre-doctoral; racial and ethnic; reduce symptoms; response; skills; theories

On any day, approximately 1.6 million Americans live in the nation’s nursing homes (NHs) and 90% of the residents are ≥ 65 years old. In the last two decades, there has been an increase in the proportion of racial/ethnic minority NH residents and a decrease in non-Latino White NH residents. Racial/ethnic minorities often reside in NHs situated in low-income communities that are poorly resourced and provide low quality of care. COVID-19 has highlighted the increased vulnerability of racial/ethnic minority NH residents. Prior to COVID-19, an estimated 25% of all deaths in the US occurred in NHs and approximately 44% of non-hospice NH residents experienced hospitalizations during the last 30 days of life. Racial/ethnic minority NH residents experience increased hospitalizations compared to non-Latino White NH residents. Many of these hospitalizations are potentially avoidable. Palliative care is essential in providing high quality end-of-life care by alleviating symptoms and providing support to patients and caregivers; yet, palliative care is suboptimal in many NHs. In preliminary work using 2017 data from the randomly sampled, national, stratified survey (n = 892) from the Study of Infection Management and Palliative Care at the End-of-Life (SIMP-EL; R01 NR013687; Stone PI and mentor), I found wide variation in NH palliative care services at the end-of-life. However, health disparities in NH palliative care services has not been studied. Furthermore, it is unknown how variations in NH palliative care services are associated with potentially avoidable hospitalizations at the end-of-life. Guided by the Gelberg-Andersen’s Behavioral Model for Vulnerable Populations, in the proposed study I will address these gaps by conducting a secondary, cross-sectional analysis using multiple data sources (i.e., the SIMP-EL survey; NH resident assessments from the Minimum Data Set 3.0; hospital claims data from the Medicare Provider and Analysis Review; NH facility characteristics from the Certification and Survey Provider Enhanced Reporting; and county level data from the Area Health Resources Files). Specifically, my aims are to: 1) Describe palliative care services provided in NHs across the nation and identify differences by population served (i.e., proportion of racial/ethnic minorities) and 2) Identify associations between palliative care services and potentially avoidable hospitalizations at the end-of-life by NH resident’s race/ethnicity. Aim 1 is a NH level analysis and Aim 2 is an individual resident level analysis. This research aligns with the National Institute of Nursing Research priority area of End-of-Life and Palliative Care Research to improve palliative care strategies for individuals and families with serious illness. To facilitate this research, the applicant will build her knowledge and skills in palliative care, quantitative research methods, and racial/ethnic health disparities. As a Latina pre- doctoral student with the dedicated mentorship of National Institutes of Health-funded interdisciplinary researchers, the resource-rich environment of Columbia University, and in response to PA-20-251, receipt of this fellowship will contribute to increasing the diversity of individuals conducting health-related research.

每天约有160万美国人住在国家养老院(NHS)，90%的美国人 居民是65岁的≥。在过去的二十年里，这一比例有所增加 种族/少数民族NH居民和非拉丁裔白人NH居民的减少。少数族裔 通常居住在位于低收入社区的NHS，这些社区资源匮乏，提供的服务质量较低 关心。新冠肺炎强调了NH种族/少数民族居民更加脆弱的问题。在.之前 新冠肺炎称，据估计，美国25%的死亡发生在国民健康保险制度，约44%发生在非临终关怀 NH居民在生命的最后30天经历了住院治疗。NH居民中的种族/少数民族 与非拉丁裔白人NH居民相比，住院人数增加。其中许多 住院治疗可能是可以避免的。姑息治疗是通过以下方式提供高质量临终关怀的关键 缓解症状并为患者和照顾者提供支持；然而，姑息治疗在 许多国民健康保险制度。在使用2017年随机抽样的全国分层调查数据的初步工作中(n= 892)来自临终感染管理和姑息护理研究(SIMP-EL；R01 NR013687； Stone Pi和Mentor)，我发现在生命末期的NH姑息治疗服务有很大的差异。然而，健康 NH姑息治疗服务的差异尚未被研究。此外，还不清楚NH是如何变化的 临终关怀服务与可能避免的临终住院有关。指导原则 Gelberg-Andersen关于弱势群体的行为模型，在拟议的研究中我将讨论 通过使用多个数据源(即，SIMP-EL)进行二次横断面分析来消除这些差距 调查；最低数据集3.0中的NH居民评估；医疗保险中的医院索赔数据 提供商和分析审查；来自认证和调查提供商的NH设施特征得到增强 报告；以及来自地区卫生资源档案的县级数据)。具体地说，我的目标是：1) 描述全国范围内NHS提供的姑息治疗服务，并按人口区分 (2)确定姑息关怀服务之间的联系 以及NH居民的种族/族裔在生命末期可能避免的住院治疗。目标1是NH水平 分析和目标2是个人居民层面的分析。这项研究与美国国立卫生研究院 临终关怀和临终关怀的护理研究重点领域改进临终关怀策略的研究 适用于患有严重疾病的个人和家庭。为了促进这项研究，申请者将建立她的知识 以及在姑息治疗、定量研究方法和种族/民族健康差异方面的技能。作为一名拉丁裔预科医生- 国立卫生研究院跨学科资助博士生专职导师 研究人员，哥伦比亚大学资源丰富的环境，并回应PA-20-251，收到 这一奖学金将有助于增加从事健康相关研究的个人的多样性。