iCAREFOR: Interhospital Care Fragmentation in Older Adults with Dementia

项目总结 当病人被重新送往与以前不同的医院时 出院后，护理就会出现碎片化。这种支离破碎的重新接纳与 有许多负面的患者结果，包括增加近两倍的风险 死亡率。这笔赠款的私人侦探萨拉·特博博士的初步分析表明， 诊断阿尔茨海默病和相关痴呆(ADRD)是一个独立的预测因素 医院间护理的支离破碎。在目标1中，她将使用医疗保险数据来估计 住院病人的护理分散与a)急诊科到达之间的关系 通过救护车或b)从急诊后护理机构赶来。我们假设救护车 使用和急性后护理机构住所将有助于更高的医院间患病率 患有ADRD的老年人的护理碎片化。在《目标2》中，特博博士将研究这种联系 在患有ADRD的老年人中，跨医院信息共享与患者预后之间的关系 通过比较通过医疗保健共享数据的医院之间的碎片化再入院 信息交换与不交换信息的人。在《目标3》中，她将对健康专业人士进行调查 并采访卫生系统领导人，以确定信息的关键障碍和促进者 在医疗保健设置之间共享。这项提议直接涉及到 国家老龄问题研究所和应对阿尔茨海默病的国家计划，特别是 为优化老年ADRD患者的护理质量和效率，以及这一技术的应用 这项研究对ADRD的痴呆症护理和健康差距研究有意义。 拟议的目标将在Dr。 Mohammed K.Ali(医疗服务研究和实施科学方面的专业知识)， Camille Vaughan(老龄化/老年病学研究方面的专长)，Molly Perkins博士(定性方面的专家 方法)、金伯利·拉斯克博士(卫生服务研究/卫生经济学专家)和Dr。 Steven Culler(医疗保险数据专家)以及Emory‘s Goizueta阿尔茨海默氏症的教职员工 疾病研究中心。埃默里大学有充足的资源让特博博士 实现了她的研究目标。她的训练计划被安排成包括在埃默里的正式授课训练 并通过加州大学旧金山分校的实施科学认证计划在线进行。这项研究的目的和 培训计划将使特博博士成为一家独立资助的医疗服务机构和 老年研究人员。

PROJECT SUMMARY When a patient is readmitted to a different hospital than the one they were previously discharged from, fragmentation of care occurs. Such fragmented readmissions are associated with a number of negative patient outcomes, including a nearly two-fold increased risk for mortality. Preliminary analyses by Dr. Sara Turbow, the PI for this grant, have shown that a diagnosis of Alzheimer’s disease and related dementias (ADRD) was an independent predictor of interhospital care fragmentation. In Aim 1, she will use Medicare data to estimate the association between inpatient fragmentation of care and either a) emergency department arrival via an ambulance or b) coming from a post-acute care facility. We hypothesize that ambulance use and post-acute care facility residence will contribute to the higher prevalence of interhospital care fragmentation in older adults with ADRD. In Aim 2, Dr. Turbow will examine the association between information sharing across hospitals and patient outcomes in older adults with ADRD by comparing fragmented readmissions between hospitals that share data via a health information exchange versus those that do not. In Aim 3, she will survey health professionals and interview health system leaders to ascertain critical barriers and facilitators to information sharing between healthcare settings. This proposal directly addresses the mission of the National Institute on Aging and of the National Plan to Address Alzheimer’s Disease, specifically to optimize care quality and efficiency for older adults with ADRD, and the applications of this research have implications for dementia care and health disparities research in ADRD. The proposed aims will be completed under the superlative mentorship of Dr. Mohammed K. Ali (expertise in health services research and implementation science), Dr. Camille Vaughan (expertise in aging/geriatrics research), Dr. Molly Perkins (expert in qualitative methods), Dr. Kimberly Rask (expert in health services research/health economics), and Dr. Steven Culler (Medicare data expert), as well as faculty at Emory’s Goizueta Alzheimer’s Disease Research Center. Emory University has ample resources to allow Dr. Turbow to carry out her research aims. Her training plan is structured to include formal didactic training at Emory and online via the UCSF Implementation Science Certification Program. The research aims and training plan will position Dr. Turbow to become an independently funded health services and aging researcher.