NIA AD/ADRD Health Care Systems Research Collaboratory

NIA AD/ADRD 医疗保健系统研究合作实验室

• 批准号: 10310637
• 负责人: SUSAN L MITCHELL
• 金额: $ 416.9万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10310637
• 关键词: 2019-nCoV; Acute; Address; Adverse effects; Affect; Alzheimer' s disease related dementia; American; Bypass; COVID-19; COVID-19 pandemic; COVID-19 vaccine; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Clinical; Cognitive; Collaborations; Communities; Complex; Computerized Medical Record; Consumption; Data; Data Linkages; Data Reporting; Databases; Disease Outbreaks; Elderly; Electronic Health Record; Engineering; Environment; Frail Elderly; Future; Geography; Health system; Healthcare; Healthcare Systems; Incidence; Individual; Infection; Intervention; Investigation; Long-Term Care; Medical; Medicare; Medicare claim; Minority; Modeling; Monitor; Morbidity - disease rate; Nursing Homes; Outcome; Policies; Policy Maker; Population; Prevalence; Provider; Public Health; Publications; Records; Research; Research Personnel; Resources; Risk; Secure; Severities; Skilled Nursing Facilities; Source; Standardization; Structure; Subgroup; Symptoms; System; Technology; Testing; Time; Touch sensation; United States Centers for Medicare and Medicaid Services; Update; Vaccinated; Vaccination; Vaccine Clinical Trial; Variant; Vendor; Virus; base; care delivery; collaboratory; commune; coronavirus disease; cost; data infrastructure; data integration; data sharing; data structure; ethnic minority population; experience; functional decline; insight; mortality; operation; pandemic disease; payment; pragmatic trial; process repeatability; public health emergency; racial minority; response; screening; surveillance data; surveillance study; systems research; transmission process; trend

ABSTRACT The Coronavirus Disease 2019 (COVID) pandemic has disproportionately affected long-term care residents in the US, who currently represent 7% of cases nationwide, but 40% of deaths. As of late November, over 100,000 residents have died, but incomplete data means these are undercounts. Skilled nursing facilities (SNFs) provide a mix of post-acute and long-term care to medically-complex older adults, about 70% of whom have Alzheimer’s Disease and Related Dementias (ADRD) and are particularly vulnerable to SARS-CoV-2. SARS-CoV-2 represents the most serious challenge to SNFs in decades because of its lethality and ease of transmission, especially by asymptomatic carriers. A major barrier to developing appropriate clinical and operational responses to mitigate the pandemic’s effects is the lack of comprehensive data. While the Centers for Medicare & Medicaid Services (CMS) and the Centers for Disease Control and Prevention (CDC) created data reporting systems, these facility-level data are insufficient to understand which residents acquire COVID or resident-level clinical outcomes. The current surveillance data offer no insight into predictors of mortality or whether these predictors have changed as the case fatality has declined since Spring of 2020.To truly understand the national impact of COVID (and similar future public health threats), a much larger, richer, and nationally representative database of SNFs is needed. This database is particularly important since residents will be vaccinated for COVID with little information on adverse effects that frail older adults may experience at higher rates or greater severity than the populations that were included in the clinical trials for these vaccines . Working with the American Health Care Association (AHCA) and two technology partners, this supplement to the IMPACT Collaboratory [U54 AG063546] will: 1) assemble an integrated database of detailed, electronic medical records data from some 10,000 US nursing homes and then merge these records with Medicare claims, creating a regularly updated data infrastructure to address clinical and policy questions pertaining to COVID (but which could apply to future conditions) such as: 2) What is the cumulative incidence of COVID among racial minorities and residents with ADRD?; 3) What influence do demographic, clinical, organizational, and regional factors have on nursing home residents’ risk of morbidity and mortality from COVID?; 4) Which nursing home residents are vaccinated against COVID and are those with ADRD and/or minorities less likely to be vaccinated?; and 5) Have the rates of physical and cognitive functional decline increased between 2019 and 2020 among residents living with ADRD, independent of COVID infection? This data infrastructure will revolutionize the rapid monitoring of nursing home trends in new infections and treatments and create a large, detailed database for quantifying the direct and indirect effects of federal and state policy changes.

摘要 冠状病毒2019年(COVID)大流行对长期护理居民的影响不成比例 在美国，世卫组织目前占全国病例的7%，但占死亡人数的40%。截至11月下旬，完毕 已有10万居民死亡，但不完整的数据意味着这些都是被低估的。熟练的护理设施 (SNF)为医疗复杂的老年人提供急性后护理和长期护理的组合，其中约70% 患有阿尔茨海默氏症和相关痴呆症(ADRD)，特别容易感染SARS-CoV-2。 SARS-CoV-2是几十年来对SNF最严峻的挑战，因为它的致命性和易感性 传播性传播，尤指无症状携带者。开发适当的临床和医疗保健服务的主要障碍 减轻大流行影响的业务对策是缺乏全面的数据。而这些中心 为Medicare&Medicaid Services(CMS)和疾病控制和预防中心(CDC)创建 数据报告系统，这些设施级别的数据不足以了解哪些居民感染了COVID 或住院医生水平的临床结果。目前的监测数据没有提供对死亡率或 自2020年春季以来，随着病死率下降，这些预测因素是否发生了变化 了解COVID(以及类似的未来公共卫生威胁)对国家的影响，一个更大、更丰富、更 需要具有全国代表性的SNF数据库。这个数据库特别重要，因为居民 将接种COVID疫苗，几乎没有关于虚弱老年人可能在 比这些疫苗的临床试验中包括的人群更高的发病率或更严重的病情。 与美国医疗保健协会(AHCA)和两个技术合作伙伴合作，本增刊 到Impact合作实验室[U54 AG063546]将：1)建立一个详细的、电子的综合数据库 美国大约10,000家疗养院的医疗记录数据，然后将这些记录与联邦医疗保险合并 创建定期更新的数据基础架构，以解决与以下相关的临床和政策问题 COVID(但可能适用于未来的情况)，例如：2)COVID的累积发病率是多少 在少数族裔和患有ADRD的居民中？3)人口，临床，组织， 以及地区因素对养老院居民患COVID的发病率和死亡率的风险？4) 疗养院居民接种了COVID疫苗，患有ADRD和/或少数民族的人不太可能 接种疫苗吗？5)2019年之间身体和认知功能衰退的比率是否有所增加 和2020年感染ADRD的居民中，与COVID感染无关的？此数据基础架构将 彻底改变对疗养院新感染和治疗趋势的快速监测，并创造一个 详细的数据库，用于量化联邦和州政策变化的直接和间接影响。