Advancing Coordination of Home and Community based Services for the ADRD Population

项目摘要 患有阿尔茨海默病和相关痴呆症（ADRD）的老年人依赖于广泛的健康和社会 提供各种服务，以满足从传统医疗保健到支持基本日常生活活动的各种需求。一 一套关键的服务是那些允许ADRD患者留在家中，而不是居住在 机构设置。这些服务被称为家庭和社区服务， 临床服务（例如，技术熟练的家庭保健，家庭姑息治疗），以服务，重点是监护和社会 需求（例如，家庭健康助理、成人日、休息）。尽管它们被广泛使用， 描述提供HCBS的组织，或者他们与传统机构的协调程度 提供者也照顾那些与ADRD。由于缺乏可获得的数据，无法调查 不同地理位置的HCBS，提供的服务范围，组织关系，质量，效率， 以及更远的地方解决这一差距对ADRD人群尤其重要，因为他们使用的是HCBS， 如此高的水平。 我们的提案是为了回应NIA PAR-19-070而提交的，重点关注痴呆症患者的HCBS，并提供 一种多方法的方法来捕获关于HCBS组织的系统数据，以及他们参与护理的程度 协同我们的方法利用HCBS新提供的医疗补助索赔/遭遇数据， 第一个公开提供的国家级数据集，列出并描述了提供HCBS的组织， ADRD人群。接下来，我们将确定组织网络-包括HCBS和机构 组织-基于哪些组织照顾同一个人。以前的工作已经定义了网络， 导致医疗保健市场的广泛使用的测量的临床提供者（例如，医院转诊区域）。 然而，这些定义并不包括六氯代苯。定义包含HCBS并服务于共享ADRD的网络 人口将允许我们表征网络的特征（例如，尺寸、扎带密度）， 评估结果（例如，医院再入院，急诊室访问），为那些照顾这些 网络.最后，通过测量和比较网络中的护理协调活动， 结果（通过对这些网络中的HCBS组织进行大规模调查），我们可以确定可行的政策 和基于实践的战略，以改善对弱势群体的照顾。综合起来，我们的结果将 为政策和实践战略提供信息，以改善对目前没有 在我们复杂和分散的医疗保健服务系统方面协调良好。

Project Summary Abstract Older adults with Alzheimer's disease and related dementias (ADRD) rely on a broad array of health and social services to address needs ranging from traditional medical care to supports for basic activities of daily living. A critical set of services is those that allow individuals with ADRD to remain at home as opposed to residing in an institutional setting. Referred to as home- and community-based services (HCBS), these services span from clinical services (e.g., skilled home health, in-home palliative care) to services that focus on custodial and social needs (e.g., home health aides, adult day, respite). Despite their widespread use, there is little data characterizing the organizations that deliver HCBS, or how well they coordinate with traditional institutional providers that also care for those with ADRD. Lack of accessible data precludes investigation into availability of HCBS across different geographies, scope of services offered, organizational relationships, quality, efficiency, and beyond. Addressing this gap is particularly essential for the ADRD population because they use HCBS at such high levels. Our proposal, submitted in response to NIA PAR-19-070, focuses on HCBS for those with dementia and offers a multi-method approach to capture systematic data on HCBS organizations and how well they engage in care coordination. Our approach leverages newly-available Medicaid claims/encounter data for HCBS to generate the first publicly-available, national-level datasets that list and characterize the organizations delivering HCBS to the ADRD population. Next, we will identify the organizational networks - including HCBS and institutional organizations – based on which organizations care for the same individuals. Prior work has defined networks of clinical providers that resulted in widely-used measures of healthcare markets (e.g., hospital referral regions). However, the definitions do not include HCBS. Defining networks that include HCBS and serve a shared ADRD population will allow us to characterize the features of the networks (e.g., size, density of ties) in addition to evaluating outcomes (e.g., hospital readmissions, emergency department visits) for those cared for by these networks. Finally, by measuring and comparing care coordination activities in networks with better and worse outcomes (via a large-scale survey of HCBS organizations in those networks), we can identify actionable policy and practice-based strategies that improve care for a vulnerable population. Taken together, our results will inform policy and practice strategies to improve delivery of HCBS for the ADRD population that are currently not well coordinated in relation to our complex and fragmented healthcare delivery system.