Home-Based Clinical Care for Persons with Dementia

痴呆症患者的家庭临床护理

• 批准号: 10689072
• 负责人: KATHERINE A ORNSTEIN
• 金额: $ 17.74万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10689072
• 关键词: Accounting; Address; Aging; Behavior; Caregivers; Caring; Characteristics; Clinical Services; Cognitive; Communities; Complex; Cost Savings; Data; Dementia; Disparity; Evolution; Family; Family Caregiver; Fostering; Future; Gender; Geographic Locations; Growth; Health; Health Policy; Health Services Accessibility; Health and Retirement Study; Home; Home Care Services; Homebound Persons; Hospitalization; Individual; Institutionalization; Investigation; Knowledge; Link; Long-Term Care; Longitudinal cohort; Medical; Medicare; Medicare claim; Methods; Neighborhoods; Nurse Practitioners; Nurses; Outcome; Patient-Focused Outcomes; Patients; Persons; Physical Function; Physician Assistants; Physicians; Population; Prevalence; Qualifying; Quality of Care; Research; Resources; Safety; Self Care; Services; Social Work; Technology; Travel; Unmarried; Vulnerable Populations; Work; access disparities; adverse outcome; burden of illness; care coordination; care delivery; care preference; caregiving; clinical care; comorbidity; cost; density; experience; family caregiving; health care availability; health care service utilization; improved; improved outcome; individual variation; insight; institutional care facility; mental function; person centered; physical therapist; population based; rapid growth; skills; social; social determinants; social factors; socioeconomics; traditional care; trend; urban area

RP4 PROJECT SUMMARY Growth in the prevalence of dementia will intensify the challenges of delivering appropriate care to persons with dementia (PWD) and their family caregivers. Consistent with care preferences and evidence of cost savings, long-term care is shifting away from institutional care facilities to the home setting. PWD are increasingly living at home throughout the course of their illness, typically with multiple comorbid illnesses requiring concurrent management. The increasing delivery of home-based clinical care holds promise for supporting PWD and their family caregivers by allowing clinicians to address the complex social, environmental, medical, and safety concerns that emerge for this population. This project will critically enhance our understanding of the lives of persons with dementia by focusing on two key components of Medicare home-based clinical care delivery: (1) home-based medical care provided by physicians, physician assistants and nurse practitioners and (2) skilled home health care provided by professionals (e.g., nurses, physical therapists) on an episodic basis for homebound individuals. Using two longitudinal cohorts, the Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS), linked to Medicare claims and geospatial data, this project will document the utilization of home-based clinical services among PWD living in the community (Specific Aim 1), evaluate disparities in receipt of home-based clinical services (Specific Aim 2), and examine the consequences of these services (Specific Aim 3). Utilizing rich longitudinal cohorts, administrative data, geospatial analysis, and rigorous methods, this project examines disparities in home-based care delivery while considering key factors such as gender, function and coexisting illness burden. We will also evaluate the consequences of use of these services for patients and families. Such information will guide care delivery for this vulnerable population in the context of a growing shift towards person-centered, home-based care. Our results will inform the evolution of home-based medical care and skilled home health care policy. They will also instruct the larger context of home-based care delivery by offering insights on what fosters high quality care for persons with dementia. The proposed analyses can serve as a platform for future investigations examining best practices for serving PWD and their caregivers. Most importantly, the knowledge generated by this proposed study is an important step in developing and expanding services to support the growing numbers of PWD.

RP4项目总结 痴呆症患病率的增长将加剧向人们提供适当护理的挑战 患有痴呆症(PWD)和他们的家庭照顾者。与护理偏好和成本证据保持一致 储蓄，长期护理正在从机构护理设施转向家庭环境。PWD是 在疾病的整个过程中，越来越多的人住在家里，通常患有多种并存疾病 需要并发管理。越来越多的家庭临床护理服务有望 通过允许临床医生解决复杂的社会问题，支持PWD及其家庭照顾者 这群人面临着环境、医疗和安全方面的担忧。这个项目将极大地增强 我们通过关注医疗保险的两个关键组成部分来理解痴呆症患者的生活 居家临床护理服务：(1)由医生、医生助理提供的居家医疗服务 和护士从业人员以及(2)由专业人员(例如护士、体检人员)提供的熟练家庭保健 治疗师)对在家的个人来说是间歇性的。使用两个纵向队列，健康和 退休研究(HRS)和国家健康和老龄化趋势研究(NHATS)，与医疗保险索赔有关 和地理空间数据，该项目将记录残障人士对家庭临床服务的使用情况 生活在社区(具体目标1)，评估在接受家庭临床服务方面的差距 (具体目标2)，并审查这些服务的后果(具体目标3)。利用丰富的纵向 通过队列、管理数据、地理空间分析和严格的方法，该项目检查了 在考虑性别、功能和并存疾病等关键因素的同时提供居家护理 负担。我们还将评估使用这些服务对患者和家庭的影响。是这样的 信息将指导为这一弱势群体提供护理的背景下， 以人为中心，以家庭为基础的护理。我们的结果将为以家庭为基础的医疗保健和 熟练的家庭保健政策。他们还将通过以下方式指导以家庭为基础的护理交付的更大背景 提供关于如何为痴呆症患者提供高质量护理的见解。建议的分析可以服务于 作为未来调查的平台，审查为残疾人士及其照顾者提供服务的最佳做法。多数 重要的是，这项拟议研究产生的知识是发展和扩大的重要一步 支持日益增多的残障人士的服务。