R01 Upstream Approaches to Improve Late Life Care for People Living with Dementia

R01 改善痴呆症患者晚年护理的上游方法

• 批准号: 10407074
• 负责人: Olga F. Jarrín Montaner
• 金额: $ 48.99万
• 依托单位: RBHS-SCHOOL OF NURSING
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10407074
• 关键词: Activities of Daily Living; Address; Admission activity; Alzheimer' s Disease; Alzheimer' s disease diagnosis; Area; Behavioral; Caring; Cessation of life; Clinical; Communities; Complex; Data; Data Set; Dementia; Development; Diagnosis; Disadvantaged; Elderly; Evaluation; Exposure to; Family; Family Caregiver; Female; Frequencies; Goals; Health; Health Services Accessibility; Health system; Home; Home Care Services; Home Health Agency; Hospitalization; Hospitals; Ice; Individual; Inpatients; Institutes; Intervention; Length; Level of Evidence; Life; Link; Medical; Medicare; Medicare/Medicaid; Modeling; Neighborhoods; Outcome; Persons; Population; Public Health; Quality Indicator; Quality of Care; Quasi-experiment; Reproducibility; Research; Research Personnel; Risk; Role; Rural; Specific qualifier value; Structure; Subgroup; Symptoms; Testing; Variant; Work; advanced disease; base; behavioral health; beneficiary; cognitive function; dementia care; design; disadvantaged population; disparity elimination; disparity reduction; end of life; end of life care; ethnic difference; ethnic disparity; ethnic minority; ethnic minority population; health care availability; health care disparity; health care service utilization; health disparity; health disparity populations; health service use; hospice environment; improved; innovation; male; minority health disparity; multilevel analysis; novel; population health; prevent; racial and ethnic; racial and ethnic disparities; racial difference; racial minority; socioeconomic disadvantage; survival outcome; treatment disparity

PROJECT SUMMARY The long-term goal is to improve the quality of end-of-life care provided to families and people living with Alz- heimer’s disease and its related dementias (dementia) by generating population-level evidence on the public health impact of community-based support structures including skilled home health care. Alzheimer’s Disease diagnosis in racial and ethnic minority populations is projected to more than double by 2030. Large racial and ethnic differences and disparities exist in well-established end-of-life care quality indicators (inpatient admis- sions, hospice use, place of death), and in people living with dementia some of these differences may be com- pounded. One understudied approach to improving dementia care among racial/ethnic minority and socioeco- nomically disadvantaged populations is the use of skilled home health care (a benefit under Medicare and Medicaid). The short-term goal for this R01 is to define racial/ethnic differences in the effects of skilled home health care on indicators of end-of-life care quality (e.g., inpatient admissions, use of hospice, and place of death) as a function of dementia diagnosis. The central hypothesis is that “upstream” exposure to home health care prior to and during the final year of life has a cumulative and beneficial effect on "downstream” end-of-life care quality indicators: (1) inpatient admissions, (2) hospice utilization, and (3) place of death. The scientific premise for this work is that PLwD have complex medical and behavioral health needs, and many rely on fam- ily caregivers to help with activities of daily living and coordination of medical care. Too few benefit from skilled home health care. As cognitive function deteriorates from mild symptoms and behavioral changes to more ad- vanced illness, skilled home health care may help prevent avoidable hospitalizations, and minimize burden- some transitions across care settings at the end-of-life. The central hypothesis will be tested by pursing three specific aims: Examine the relationship between receiving skilled home health care prior to and during the last year of life and: 1) inpatient admissions (type, frequency and length) in the last year of life, 2) hospice utiliza- tion (timing and setting) in the last year of life, and 3) place of death (e.g., hospital, home, hospice in a hospital, hospice at home). The aims will be tested using linked Medicare data sets to examine the effect of skilled home health care utilization on racial and ethnic disparities in end-of-life outcomes among people diagnosed with dementia compared to people not diagnosed with dementia. The research proposed in this application is innovative, in the applicant’s opinion, because it focuses on evaluating an underutilized core benefit of Medi- care through evaluating the effect of skilled home health care access on disparities in dementia care quality. Successful completion of proposal aims will have a sustained and powerful impact by providing needed and actionable evidence to reduce disparities in care for racial and ethnic minority older adults living with dementia. The project will significantly impact the design, development, and evaluation of population health system inter- ventions to eliminate or reduce disparities in care and end-of-life outcomes among people living with dementia.

项目摘要 长期目标是提高为阿尔茨海默病患者家庭和患者提供的临终关怀的质量， 海默氏病及其相关的痴呆症（痴呆症）通过产生人口水平的证据，对公众 以社区为基础的支助结构对健康的影响，包括熟练的家庭保健。阿尔茨海默病 预计到2030年，少数种族和族裔人口的诊断将增加一倍以上。大种族和 种族差异和差距存在于完善的临终关怀质量指标（住院管理人员， 在老年痴呆症患者中，其中一些差异可能是共同的。 捣碎的一种未充分研究的方法，以改善种族/少数民族和社会经济中的痴呆症护理， 在名义上处于不利地位的人口是使用熟练的家庭保健（根据医疗保险和 Medicaid）。本R01的短期目标是定义熟练家庭护理的影响中的种族/民族差异， 健康护理对临终护理质量指标的影响（例如，住院病人，临终关怀的使用，以及 死亡）作为痴呆症诊断的函数。中心假设是，"上游"暴露于家庭健康 生命最后一年之前和期间的护理对“下游”生命终结具有累积和有益的影响 照护品质指标：（1）住院人数、（2）安宁疗护利用、（3）死亡地点。科学 这项工作的前提是，PLwD有复杂的医疗和行为健康需求，许多人依赖家庭， 协助护理人员进行日常生活活动和协调医疗护理。受益于熟练技能的人太少 家庭保健。随着认知功能从轻微症状和行为变化恶化到更多的ad- 晚期疾病，熟练的家庭保健可能有助于防止可避免的住院，并尽量减少负担- 在临终关怀环境中的一些过渡。中心假设将通过追求三个 具体目标：检查在最后一次治疗之前和期间接受熟练的家庭保健之间的关系， 1）生命最后一年的住院（类型，频率和长度），2）临终关怀利用率- 在生命的最后一年，以及3）死亡的地点（例如，医院，家庭，医院的临终关怀， 家的安宁）。这些目标将使用相关的医疗保险数据集进行测试，以检查熟练的 家庭卫生保健利用对被诊断患者临终结局种族和民族差异的影响 与未被诊断为痴呆症的人相比。本申请中提出的研究是 创新，在申请人的意见，因为它侧重于评估一个未充分利用的核心利益的医疗， 通过评估熟练的家庭卫生保健服务对痴呆症护理质量差异的影响， 成功完成提案目标将通过提供所需和 可采取行动的证据，以减少种族和少数民族老年痴呆症患者的护理差异。 该项目将对人口健康系统的设计、开发和评估产生重大影响， 消除或减少痴呆症患者在护理和临终结果方面的差异。