Surgeon and hospital factors associated with racial and ethnic disparities in surgical outcomes among persons with AD/ADRD

与 AD/ADRD 患者手术结果的种族和民族差异相关的外科医生和医院因素

• 批准号: 10711241
• 负责人: Yusuke Tsugawa
• 金额: $ 36.91万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-12 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10711241
• 关键词: Address; Affect; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease patient; American Hospital Association; American Medical Association; Association of American Medical Colleges; Black race; Caring; Cessation of life; Characteristics; Clinical Trials; Communication; Data; Data Set; Databases; Decision Making; Dementia; Disparity; Educational process of instructing; Ensure; Future; Goals; Health system; Healthcare; Hip Fractures; Hispanic; Hospitals; Impaired cognition; Intervention; Knowledge; Length of Stay; Link; Medical Residency; Medical Students; Medicare claim; Methods; National Institute on Minority Health and Health Disparities; Operative Surgical Procedures; Outcome; Parents; Patient Preferences; Patients; Persons; Pharmaceutical Preparations; Physical Function; Physicians; Play; Population; Postoperative Period; Process; Research; Research Personnel; Residencies; Role; Schools; Services; Surgeon; Surveys; Testing; United States Agency for Healthcare Research and Quality; Vulnerable Populations; accountable care organization; caregiving; cultural competence; dementia care; disparity reduction; ethnic disparity; ethnic diversity; ethnic minority; experience; gender diversity; health care disparity; high risk; hospital readmission; innovation; interdisciplinary approach; medical schools; member; minority communities; minority patient; mortality; operation; patient-clinician communication; programs; provider communication; racial disparity; racial diversity; racial minority; surgery outcome; surgical disparities

Abstract This proposed supplement examines the racial and ethnic (R/E) disparities in surgical outcomes and potential contributing factors—such as surgeon and hospital characteristics—among persons with Alzheimer’s disease and its related dementias (AD/ADRD) who undergo surgery. Due to the aging of the population, it has become increasingly common for persons with AD/ADRD to undergo a surgical procedure, with hip fracture being the most frequent indication. Existing studies have shown that patients from R/E minoritized communities undergoing surgery experience higher mortality, complications, and readmissions than White patients. Similarly, R/E disparities in AD/ADRD care, including the use of medications and long-term services, caregiving, and mortality, are well documented. However, little is known regarding R/E disparities in surgical outcomes among persons with AD/ADRD undergoing surgery. To address this knowledge gap, we will leverage the parent NIMHD project that examines surgeon characteristics associated with R/E disparities in surgical outcomes using a comprehensive dataset consisting of Medicare claims data, the Doximity physician database, the Association of American Medical Colleges Medical School database, and the American Medical Association Residency database. In Aim 1, we will determine whether the R/E disparities in surgical outcomes (e.g., length of stay, complications, 30-day, 90-day, and 1-year operative mortality) differ between surgical patients with AD/ADRD compared to those without AD/ADRD. We hypothesize that R/E disparities in surgical outcomes are exacerbated among persons with AD/ADRD because of their vulnerabilities and challenges with communicating with clinicians effectively, which is an important contributor to disparities. In Aim 2, we will identify surgeon characteristics associated with R/E disparities in surgical outcomes among persons with AD/ADRD. We hypothesize that certain characteristics of surgeons (e.g., age, gender, R/E diversity of medical school and residency program, number of R/E minoritized patients treating) are associated with larger or smaller disparities in surgical outcomes among persons with AD/ADRD. In Aim 3, we will identify hospital characteristics associated with R/E disparities in surgical outcomes among persons with AD/ADRD. We hypothesize that certain hospital characteristics (e.g., teaching status, accountable care organization participation, diversity of board members) are associated with disparities in surgical outcomes among persons with AD/ADRD. We will additionally link the American Hospital Association Hospital database, the American Hospital Association National Health Care Governance Survey data, and the AHRQ Compendium of US Health Systems to obtain hospital characteristics. This project will identify potentially modifiable factors associated with disparities in persons with AD/ADRD who undergo surgery and inform future interventions to reduce disparities in this vulnerable population.

摘要