Racial/Ethnic Disparities in Health Care and Challenges in Insurance Plan Choices among Older People with Alzheimer’s Disease and Related Dementia: A Mixed Methods Study of Medicare Options

患有阿尔茨海默病和相关痴呆症的老年人在医疗保健方面的种族/民族差异以及保险计划选择的挑战：医疗保险选项的混合方法研究

• 批准号: 10723148
• 负责人: Elham Mahmoudi
• 金额: $ 72.68万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10723148
• 关键词: Academy; Adverse event; Advisory Committees; Alzheimer' s disease related dementia; Back; Black race; Caregivers; Caring; Characteristics; Communities; Complex; Continuity of Patient Care; County; Data; Data Analyses; Decision Making; Disadvantaged; Disparity; Elderly; Eligibility Determination; Enrollment; Equitable healthcare; Equity; Ethnic Origin; Event; Fee-for-Service Plans; Goals; Growth; Health; Health Insurance; Health Policy; Healthcare; Hispanic; Hospital Costs; Hospitalization; Inpatients; Interview; Lead; Length of Stay; Maps; Measures; Medicare; Medicare claim; Medicine; Methods; Modeling; Policies; Positioning Attribute; Preventive care; Preventive service; Prospective Payment System; Qualifying; Quality of Care; Race; Reporting; Research; Risk; Sampling; Selection Bias; Structure; Variant; beneficiary; care coordination; design; disparity reduction; econometrics; eligible participant; ethnic disparity; ethnic health disparity; ethnic minority; experience; health care disparity; health plan; high risk; hospital readmission; innovation; insurance plan; mortality; multidisciplinary; patient population; payment; racial disparity; racial health disparity; racial minority; socioeconomic disadvantage; theories; treatment effect

Project Summary/Abstract Medicare is the primary health insurance for older adults (65+) living in the U.S. Eligible beneficiaries must choose between two different plan types: traditional Medicare (TM) and Medicare Advantage (MA). MA enrollment has doubled in the last decade, currently covering about 45% of all Medicare beneficiaries. This growth has been driven, in part, by an increasing proportion of Black and Hispanic MA enrollees. While evidence suggests that some MA patient populations receive better-quality care and experience fewer racial/ethnic health disparities, it is unknown whether this is true for socioeconomically disadvantaged Black and Hispanic Medicare beneficiaries, who are at substantially greater risk of incident Alzheimer’s disease and related dementia (ADRD). Because they have more complex healthcare needs but receive less coordinated care and fewer preventive services, they are at significantly higher risk of potentially preventable hospitalization, 30-day hospital readmission, and other adverse health events than their White counterparts. Further, there is considerable variation in the quality of MA plans. Many MA plans in Black- and Hispanic- populated counties have low quality ratings, which may contribute to racial/ethnic health disparities. Moreover, beneficiaries’ health plan decision-making is complex, potentially exacerbating racial/ethnic health disparities among ADRD beneficiaries. Finally, racial/ethnic health care disparity research has been mainly observational and descriptive, thus limiting its usefulness in informing policy. The specific aims of this mixed methods study are to use innovative econometric causal methods to (1) examine and explain racial/ethnic disparities in 16 measures of care continuity, receipt of preventive services, and quality of care in MA vs. TM; (2) examine racial/ethnic disparities within and between MA plans in 16 measures of care continuity, receipt of preventive services, and quality of care; and (3) explore health plan decision-making challenges among beneficiaries with ADRD and/or their caregivers. Our multidisciplinary team, with decades of experience in ADRD research, racial/ethnic healthcare disparity analysis, claims data and econometrics, qualitative and mixed methods, and health policy is uniquely qualified to conduct this innovative research. This study will inform Medicare policies to promote more equitable health care and facilitate easier health plan decision-making for socioeconomically disadvantaged Black and Hispanic Medicare beneficiaries with ADRD. With our national Policy Advisory Committee of stakeholders, including a beneficiary with ADRD and/or a caregiver, we are well-positioned to disseminate findings and promote quality and equitable health care for racial/ethnic minority Medicare beneficiaries with ADRD.

项目摘要/摘要 Medicare是居住在美国合格受益人必须的老年人（65岁以上）的主要健康保险 在两种不同的计划类型之间进行选择：传统医疗保险（TM）和Medicare Advantage（MA）。马 在过去的十年中，入学率翻了一番，目前约占所有医疗保险受益人的45％。这 在某种程度上，黑人和西班牙裔MA招收的比例越来越多地推动了增长。尽管 有证据表明，一些MA患者人群获得更好的护理，经验更少 种族/种族健康差异，尚不清楚这对于在社会经济上处于不利地位的黑人是正确的 以及西班牙裔医疗保险受益人，他们面临着发生异教徒病的风险和 相关痴呆（ADRD）。因为他们有更复杂的医疗保健需求，但协调不足 护理和更少的预防服务，它们的潜在预防风险显着更高 与白人同行相比，住院，30天的医院再入院和其他不良健康事件。 此外，MA计划的质量有很大差异。黑人和西班牙裔的许多硕士计划 人口稠密的县的评级低，这可能导致种族/种族健康差异。而且， 受益人的健康计划决策很复杂，可能加剧种族/种族健康差异 在Adrd受益人中。最后，种族/族裔医疗保健差异研究主要是观察性的 并描述性，从而限制了其在为政策提供信息的用处。这项混合方法研究的具体目的 要使用创新的经济因果方法来（1）检查和解释16中的种族/种族分布 MA与TM中的护理连续性，预防服务的接收和护理质量； （2） 在16个护理连续性的措施中，MA计划内和之间的种族/种族差异， 收到预防服务和护理质量； （3）探索健康计划决策 ADRD和/或其护理人员的受益人之间的挑战。我们的多学科团队， 数十年的ADRD研究经验，种族/种族医疗保健差异分析，索赔数据和 经济学，定性和混合方法以及健康政策具有独特的资格来进行这一创新性 研究。这项研究将告知医疗保险政策，以促进更公平的医疗保健并促进更容易 针对社会经济上处于不利地位的黑人和西班牙裔医疗保险受益人的健康计划决策 与Adrd。与我们的国家利益相关者政策咨询委员会，包括ADRD的受益人 和/或护理人员，我们有充分的位置来传播发现并促进质量和公平健康 护理ADRD的种族/族裔医疗保险受益人。