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

项目摘要摘要 患有阿尔茨海默病和相关痴呆(ADRD)的老年人依赖于广泛的健康和社会 满足从传统医疗到日常生活基本活动支持的各种需求的服务。一个 关键服务集是那些允许ADRD患者留在家中而不是居住在 机构设置。这些服务被称为基于家庭和社区的服务(HCBS)，范围从 临床服务(例如，熟练的家庭健康、居家姑息治疗)到以监护和社交为重点的服务 需要(例如，家庭保健助理、成人日、休息时间)。尽管它们被广泛使用，但几乎没有数据 介绍提供HCBS的组织的特点，或它们与传统机构的协调情况 提供者也照顾那些患有ADRD的人。缺乏可访问的数据阻碍了对可获得性的调查 跨不同地域、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人口尤其重要，因为他们在 如此高的水平。 我们的提案是对NIA PAR-19-070的回应，重点是针对痴呆症患者的HCBS和优惠 一种多方法方法来捕获关于HCBS组织及其参与护理的情况的系统数据 协调。我们的方法利用新提供的医疗补助申领/遭遇数据，以供HCBS生成 第一个公开可用的国家级数据集，列出并描述了向 ADRD的人口。接下来，我们将确定组织网络--包括母婴健康中心和机构 组织-基于哪些组织关心相同的个人。以前的工作已经定义了 临床提供者产生了医疗保健市场的广泛使用的衡量标准(例如，医院转诊地区)。 然而，这些定义不包括六氯联苯。定义包括HCB并服务于共享ADRD的网络 人口将使我们能够描述网络的特征(例如，大小、联系密度)以及 评估这些护理人员的结果(例如，重新入院、急诊科就诊) 网络。最后，通过测量和比较护理协调活动在网络中的优劣 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 以及以实践为基础的战略，以改善对弱势群体的护理。总而言之，我们的结果将 告知政策和实践战略，以改善向ADRD人口提供六氯苯的情况，但目前还没有 与我们复杂和支离破碎的医疗保健提供系统密切相关的协调。

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.