The Role of Physician Networks on Racial Disparities in Intensity of Care for Dementia Patients

医生网络对痴呆症患者护理强度种族差异的作用

• 批准号: 9297474
• 负责人: Andrea Austin
• 金额: $ 8.1万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9297474
• 关键词: Address; African American; Age; Alzheimer' s Disease; Ambulatory Care; Area; Behavior; Caring; Categories; Characteristics; Data; Dementia; Diabetes Mellitus; Diagnosis; Diffusion; Disease; Elderly; Enteral Feeding; Ethnic group; Exposure to; Future; Generations; Goals; Health Services; Health Services Research; Health behavior outcomes; Hypertension; Knowledge; Life; Link; Measures; Medical; Medicare; Medicare claim; Methodology; Methods; Minority; Morbidity - disease rate; Older Population; Outcome; Patient Preferences; Patients; Pattern; Patterns of Care; Pharmaceutical Preparations; Physician' s Practice Patterns; Physician' s Role; Physicians; Play; Positioning Attribute; Prevalence; Primary Care Physician; Probability; Provider; Quality of Care; Race; Risk; Role; Social Interaction; Social Network; Structure; Symptoms; Time; Training; behavior influence; beneficiary; dementia care; design; disparity reduction; end of life; end of life care; experience; health care disparity; health care quality; health difference; health economics; mortality; patient population; racial disparity; racial minority; tool; treatment disparity

PROJECT SUMMARY Alzheimer’s disease and other related dementias (ADRD) are widely acknowledged as a major cause of morbidity and mortality in older populations. There are racial disparities in prevalence, with older African-Americans being twice as likely as older whites of having ADRD, with more severe symptoms at the time of diagnosis. Treatment intensity of people with ADRD is well documented to differ by race, including differences in health services received such as medication use and end of life care patterns. For example, African-Americans have 1.77 times the risk of having a feeding tube placed at the end of life than white patients. While differences in patient preference across racial and ethnic groups are documented, one major gap in our knowledge is what role physician practice characteristics have on disparities. While disparities could exist because the same physician is treating African-American and white patients differently, an alternative could be that people of different races with ADRD are seen largely by different physicians, with varying experience with either dementia or racial minorities. Furthermore, physicians seeing minority dementia patients may be in completely different physician “networks,” meaning minorities see physicians who have differential connections to providers with specialized ability to diagnose and treat people with dementia. The influence of physician professional connections on behavior can be studied by drawing on methods developed for the study of social networks. Social networks are structural representations of social interactions and personal or professional relationships. For physicians, social networks consist of colleagues with whom they share information, which can be measured by inferring connections when physicians share patients. The goal of this R03 is to develop preliminary data and methods to study the influence of social networks of physicians on disparities in end of life (EOL) care delivered to white and African-American Medicare beneficiaries with ADRD. We propose to address these questions developing social networks of physicians who provide EOL care to dementia patients, stratified by race, and study how these networks are associated with the quality and racial disparities of that care. Thus, this R03 is designed to: (1) construct and summarize physician patient-sharing networks for dementia patients and describe the relationship between network characteristics of their predominant provider of care and end of life outcomes; and (2) elucidate the relationship between physician patient-sharing networks and the disparities by race in intensity and quality of care received at the end of life for dementia patients. With greater understanding of the relationship between disparities in quality of care and physician networks, this R03 will form the basis for future research at Dartmouth to inform new areas of health economic and services research, and potentially many other questions regarding physician influence of healthcare quality and use for people with Alzheimer’s disease.

项目摘要 阿尔茨海默病和其他相关痴呆症（ADRD）被广泛认为是老年人群发病率和死亡率的主要原因。患病率存在种族差异，老年非洲裔美国人患ADRD的可能性是老年白人的两倍，在诊断时症状更严重。ADRD患者的治疗强度因种族而异，包括所接受的医疗服务的差异，如药物使用和临终护理模式。例如，非洲裔美国人在生命结束时放置喂食管的风险是白色患者的1.77倍。虽然记录了不同种族和民族的患者偏好差异，但我们知识中的一个主要差距是医生实践特征对差异的作用。虽然差异可能存在，因为同一位医生对非洲裔美国人和白色患者的治疗方式不同，但另一种可能是不同种族的ADRD患者主要由不同的医生就诊，他们对痴呆症或少数民族有不同的经验。此外，为少数群体痴呆症患者看病的医生可能处于完全不同的医生“网络”中，这意味着少数群体看到的医生与具有诊断和治疗痴呆症患者专业能力的提供者有不同的联系。 医生职业关系对行为的影响可以通过借鉴为社交网络研究开发的方法来研究。社交网络是社会互动和个人或职业关系的结构表示。对于医生来说，社交网络由他们分享信息的同事组成，这可以通过医生分享病人时的联系来衡量。本R 03的目标是开发初步数据和方法，以研究医生的社交网络对向患有ADRD的白色和非裔美国人医疗保险受益人提供的临终（EOL）护理差异的影响。我们建议解决这些问题，发展社交网络的医生谁提供终末期护理痴呆症患者，按种族分层，并研究这些网络是如何与质量和种族差异的照顾。因此，本R 03旨在：（1）构建和总结痴呆患者的医生患者共享网络，并描述其主要护理提供者的网络特征与生命终末期结局之间的关系;（2）阐明医生患者共享网络与痴呆患者生命终末期接受的护理强度和质量的种族差异之间的关系。随着对护理质量差异和医生网络之间关系的进一步了解，R 03将成为达特茅斯未来研究的基础，为卫生经济和服务研究的新领域提供信息，并可能涉及医生对阿尔茨海默病患者医疗质量和使用的影响的许多其他问题。