A Longitudinal Network Study of Alzheimer's and Dementia Care in Relation to Disparities in Access and Outcomes

项目摘要/摘要 阿尔茨海默病和相关痴呆(AD/痴呆症)代表着一个迫在眉睫的公众 健康危机，影响到美国大约500万人和11%的老年人。与其他产品一样 慢性病、种族/族裔和社会经济差距普遍存在， 疾病的负担。然而，人们对获得医疗服务的差距如何影响 医疗轨迹--即医疗保健服务的范围、频率和顺序 设置--AD/痴呆症患者。这项回溯性的纵向队列研究将解决 这一差距是通过使用网络分析来检查种族和 社区居住的阿尔茨海默病/痴呆症患者和 不明原因的认知障碍(CI)，可能存在延迟诊断AD/痴呆的风险。 该队列将包括由纽约探访护士服务处提供服务的家庭保健患者 约克(VNSNY)，一家大型非营利家庭护理提供商。数据将包括以下方面的临床评估 2010-2012年间，大约有89,000名患者入院接受家庭护理，这与4年的 Medicare和Medicaid索赔数据和社区服务的地理数据。这个 具体目标是： (1)描述两个诊断类别(阿尔茨海默病/痴呆症)的VNSNY人群 和未指明的CI)与不良后果(如压疮、跌倒、感染、 脱水、可预防的住院和疗养院入院)； (2)绘制、量化和比较个人和群体的护理轨迹模式 经历不同和/或不同结果的人；以及 (3)确定实施有可能减少的护理轨迹的战略 阿尔茨海默病/痴呆症和未指明CI的机会和/或结果方面的差异。 应用系统科学框架，这项研究将使用创新的网络分析来 捕获护理轨迹中可能导致不良结果的复杂模式 种族和社会经济上不同的有这两种情况的个体样本。这个 这项研究的长期目标是确定并在随后的研究中测试潜在的家园-以及 以社区为基础的干预措施，可改善获得服务的机会和成果 可能得不到充分服务或面临未得到满足的医疗需求的高风险的个人。这 研究将产生新的知识，以帮助缩小这一领域的健康差距 脆弱且不断增长的人口。

PROJECT SUMMARY/ABSTRACT Alzheimer's disease and related dementias (AD/dementia) represent a looming public health crisis, affecting roughly 5 million people in the U.S. and 11% of older adults. As with other chronic conditions, racial/ethnic and socio-economic disparities exist in the prevalence and burden of illness. However, less is known about how disparities in access to care influence the care trajectories – i.e. the scope, frequency and sequence of services used across health care settings – of those with AD/dementia. This retrospective, longitudinal cohort study will address this gap by using network analysis to examine care trajectories and outcomes in a racially and socioeconomically diverse sample of community-dwelling individuals with AD/dementia and unspecified cognitive impairment (CI) who may be at risk for a delayed AD/dementia diagnosis. The cohort will consist of home health care patients served by the Visiting Nurse Service of New York (VNSNY), a large, non-profit home care provider. Data will include clinical assessments for roughly 89,000 patients admitted to home care during 2010-2012 linked with 4 years of Medicare and Medicaid claims data and geographic data on neighborhood services. The specific aims are to: (1) Describe the population at VNSNY within two diagnostic categories (AD/dementia and unspecified CI) in relation to adverse outcomes (e.g. pressure ulcers, falls, infection, dehydration, preventable hospitalization, and nursing home admission); (2) Map, quantify and compare patterns in the care trajectories of individuals and groups that experience variable and/or disparate outcomes; and (3) Identify strategies for implementing care trajectories with potential to reduce disparities in access and/or outcomes for AD/dementia and unspecified CI. Applying a systems science framework, the study will use innovative network analytics to capture complex patterns in care trajectories that may contribute to adverse outcomes in a racially and socioeconomically diverse sample of individuals with these two conditions. The long-term goal of this research is to identify and, in subsequent studies, test potential home- and community-based interventions that may improve access to services and outcomes for individuals who may be underserved or at heightened risk for unmet healthcare needs. This research will produce new knowledge to aid efforts to mitigate health disparities in this vulnerable and growing population.