Home-Based Clinical Care for Persons with Dementia

RP4项目总结 痴呆症发病率的增加将加剧向人们提供适当护理的挑战。 失智症（PWD）患者及其家庭照顾者。与护理偏好和成本证据一致 随着储蓄的增加，长期护理正在从机构护理设施转向家庭环境。PWD是 越来越多的人在整个疾病过程中住在家里，通常患有多种共病 需要并行管理。越来越多的以家庭为基础的临床护理提供了希望， 通过允许临床医生解决复杂的社会问题， 环境、医疗和安全问题。该项目将大大提高 我们通过关注医疗保险的两个关键组成部分来了解痴呆症患者的生活 以家庭为基础的临床护理服务：（1）由医生、医生助理 和执业护士以及（2）由专业人员提供的熟练的家庭保健（例如，护士，物理 治疗师）对居家的个人进行间歇性治疗。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 及地理空间数据，本项目将记录残疾人士使用家居临床服务的情况 生活在社区（具体目标1），评估接受家庭临床服务的差异 （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 队列，行政数据，地理空间分析和严格的方法，该项目审查的差异， 在考虑性别、功能和共存疾病等关键因素的同时， 负担我们还将评估使用这些服务对患者和家庭的影响。等 信息将指导在日益转向 以人为本的家庭护理我们的研究结果将为家庭医疗保健的发展提供信息， 熟练的家庭保健政策。他们还将指导更大的背景下，以家庭为基础的护理提供， 提供关于促进痴呆症患者高质量护理的见解。所提出的分析可以服务于 作为未来调查的平台，研究为残疾人及其照顾者提供服务的最佳做法。最 重要的是，这项拟议研究所产生的知识是发展和扩大 为越来越多的残疾人提供服务。

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.