The Impact of Advanced Practice Clinicians on End of Life Outcomes for Older Adults with Dementia

高级实践临床医生对痴呆症老年人临终结局的影响

• 批准号: 10341076
• 负责人: Md Momotazur Rahman
• 金额: $ 48.99万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-15 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10341076
• 关键词: Acute; Address; Admission activity; Advance Care Planning; Alzheimer' s Disease; Alzheimer' s disease related dementia; Caregivers; Caring; Censuses; Cessation of life; Characteristics; Client satisfaction; Communities; Country; Coupled; Cross-Sectional Studies; Data; Dementia; Do Not Resuscitate Order; Effectiveness; Elderly; Enteral Feeding; Exposure to; Face; Family; Fee-for-Service Plans; Geographic state; Goals; Health Personnel; Health system; Hospitalization; Hospitals; Individual; Intensive Care Units; Intervention; Knowledge; Life; Link; Literature; Location; Managed Care; Medicaid; Medical; Medically Underserved Area; Medicare; Medicare claim; Minority; Modeling; National Institute on Aging; Nurse Practitioners; Nursing Homes; Outcome; Outpatients; Palliative Care; Patient Care; Patients; Persons; Pharmaceutical Preparations; Physician Assistants; Physicians; Play; Policies; Population; Primary Care Physician; Primary Health Care; Provider; Quality of Care; Regulation; Research; Resources; Rights; Role; Safety; Schools; Services; Testing; Training; Work; acute care; base; beneficiary; care systems; community setting; demographics; design; dual eligible; end of life; end of life care; health care service organization; hospice environment; improved; recruit; reduce symptoms; rural underserved; skills

ABSTRACT Individuals with Alzheimer’s disease and related dementias (ADRD) often face hospitalizations and other burdensome interventions at end of life that could be avoided with better preemptive medical care – specifically, early recognition and treatment of acute illness, improved advance care planning and palliative care, and availability of resources to manage acute conditions in the outpatient setting. Nurse practitioners and physician assistants, collectively known as advanced practice clinicians (APCs), are playing an increasingly important role in the medical management of older adults in both nursing home and community settings, yet little is known about how these clinicians influence end of life outcomes for people with ADRD under traditional fee-for-service Medicare. Additionally, APC scope of practice is governed by state regulations which vary considerably and it is unknown how these regulations impact the provision of end of life care to people with ADRD, particularly those living in rural or medically underserved areas. The long-term goal of this research is to develop evidence that will inform workforce planning and policy efforts to provide high quality care to people with ADRD at end of life. Our central hypotheses are that APCs provide services to vulnerable sub-populations of people with ADRD who may otherwise have poor access to quality end of life care; and that the involvement of APCs in care reduces the likelihood of being exposed to burdensome interventions at end of life. To test these hypotheses, we propose a cross-sectional study using 2015-2018 Medicare claims and administrative data with the following specific aims: (1) To describe population and state regulatory characteristics associated with people with ADRD receiving care from APCs at end of life; (2) To evaluate whether APC care is associated with acute care utilization in the last month of life, death in a hospital, hospice utilization, and feeding tube placement for people with ADRD; and (3) To evaluate whether the effects of APC care on end of life outcomes vary across states with different scope of practice regulations. This will be the first study to examine the impact of APCs on end of life outcomes for individuals with ADRD, or for any population of Medicare beneficiaries. Findings from this study will inform staffing composition for nursing homes, physician practices, and other healthcare organizations that care for people with ADRD; provide guidance to state policymakers who design APC scope of practice regulations; and inform workforce planning, training, and recruitment efforts for schools and healthcare organizations.

摘要 患有阿尔茨海默病和相关痴呆症（ADRD）的个体经常面临住院治疗和其他疾病。 在生命结束时进行繁重的干预，可以通过更好的先发制人的医疗护理来避免- 具体地说，早期识别和治疗急性疾病、改进预先护理规划和姑息治疗， 护理和资源的可用性，以管理急性条件在门诊设置。执业护士和 医生助理，统称为高级实践临床医生（APC），正在发挥越来越多的作用。 在护理之家和社区环境中老年人的医疗管理中发挥重要作用，但 关于这些临床医生如何影响ADRD患者在传统治疗方案下的生命结局， 按服务收费的医疗保险此外，APC的实践范围受各州法规的管辖， 目前还不清楚这些法规如何影响向患有糖尿病的人提供临终关怀。 ADRD，特别是生活在农村或医疗服务不足地区的人。这项研究的长期目标是 开发证据，为劳动力规划和政策工作提供信息，为人们提供高质量的护理 在生命的尽头，我们的中心假设是APC为弱势亚群体提供服务 ADRD患者可能无法获得高质量的临终关怀;参与 护理中的APC减少了在生命结束时暴露于繁重的干预措施的可能性。测试 这些假设，我们提出了一个横断面研究，使用2015-2018年医疗保险索赔和行政 数据具有以下具体目的：（1）描述与人口和国家监管特征相关的 ADRD患者在生命末期接受APC治疗;（2）评估APC治疗是否 与生命最后一个月的急性护理利用率、医院死亡率、临终关怀利用率以及 ADRD患者的饲管放置;（3）评估APC护理对ADRD结束的影响， 各州的生活结果各不相同，执业条例的范围也各不相同。这将是第一项研究， 检查APC对ADRD个体或任何 医疗保险受益人这项研究的结果将告知养老院的人员组成，医生 实践和其他护理ADRD患者的医疗保健组织;为国家提供指导 设计APC实践法规范围的决策者;并为劳动力规划、培训和 学校和医疗机构的招聘工作。

项目成果

Socioeconomic Disparities in Community Mobility Reduction and COVID-19 Growth.

• DOI: 10.1016/j.mayocp.2020.10.019
• 发表时间: 2021-01
• 期刊: Mayo Clinic proceedings
• 影响因子: 8.9
• 作者: Ossimetha A;Ossimetha A;Kosar CM;Rahman M
• 通讯作者: Rahman M

Advanced practice clinician care and end-of-life outcomes for community- and nursing home-dwelling Medicare beneficiaries with dementia.

为患有痴呆症的社区和疗养院医疗保险受益人提供先进的临床医生护理和临终结果。

• DOI: 10.1002/alz.13052
• 发表时间: 2023
• 期刊: Alzheimer's & dementia : the journal of the Alzheimer's Association
• 作者: Oh,Hyesung;White,ElizabethM;Muench,Ulrike;Santostefano,Christopher;Thapa,Bishnu;Kosar,Cyrus;Gadbois,EmilyA;Osakwe,ZainabToteh;Gozalo,Pedro;Rahman,Momotazur
• 通讯作者: Rahman,Momotazur

Assessment of Rural-Urban Differences in Health Care Use and Survival Among Medicare Beneficiaries With Alzheimer Disease and Related Dementia.

• DOI: 10.1001/jamanetworkopen.2020.22111
• 发表时间: 2020-10-01
• 期刊: JAMA network open
• 影响因子: 13.8
• 作者: Rahman M;White EM;Thomas KS;Jutkowitz E
• 通讯作者: Jutkowitz E