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

项目总结/摘要 阿尔茨海默病和相关痴呆症（AD/痴呆症）代表了一个迫在眉睫的公众 健康危机，影响美国约500万人和11%的老年人。与其他 慢性病、种族/族裔和社会经济方面的差异， 疾病的负担。然而，很少有人知道获得保健的不平等如何影响 护理轨迹-即整个卫生保健使用的服务的范围、频率和顺序 AD/痴呆症患者。这项回顾性、纵向队列研究将探讨 这一差距，通过使用网络分析，以审查护理轨迹和结果，在种族和 社会经济多样化的社区居住AD/痴呆患者样本， 未指明的认知障碍（CI），可能存在延迟AD/痴呆诊断的风险。 该队列将包括由新的探访护士服务提供服务的家庭健康护理病人。 约克（VNSNY），一家大型非营利家庭照护提供者。数据将包括以下方面的临床评估 2010-2012年期间，约有89，000名患者接受家庭护理， 医疗保险和医疗补助索赔数据和邻里服务的地理数据。的 具体目标是： (1)描述VNSNY中两种诊断类别（AD/痴呆）的人口 和未指明的CI）与不良结局（例如，压疮、福尔斯、感染， 脱水、可预防的住院治疗和入住疗养院）; (2)绘制、量化和比较个人和团体的护理轨迹模式 经历可变和/或完全不同的结果;以及 (3)确定实施护理轨迹的战略，有可能减少 AD/痴呆和未指明CI的可及性和/或结局差异。 应用系统科学框架，该研究将使用创新的网络分析， 捕捉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样本的个人与这两个条件。的 这项研究的长期目标是确定，并在随后的研究中，测试潜在的家庭和 以社区为基础的干预措施，可以改善获得服务和成果， 可能得不到充分服务或面临未满足医疗保健需求的高风险的个人。这 研究将产生新的知识，以帮助努力减轻健康差距， 脆弱和不断增长的人口。

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.