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Barriers to early identification of dementia in a safety net healthcare system

安全网医疗保健系统中早期识别痴呆症的障碍

基本信息

批准号：
10728164
负责人：
Elizabeth Bartelt Joe
金额：
$ 16.55万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10728164
关键词：
Address Adoption Adult Affect Aging Alzheimer&apos s Disease Awareness Behavioral Belief Black race Caregivers Caring Clinical Complement Country County Data Data Set Dementia Demographic Factors Diagnosis Diagnostic Diagnostic tests Disadvantaged Disease Disparity in diagnosis Early identification Elderly Electronic Health Record Eligibility Determination Equity Evaluation Family Family member Fright Future Goals Health Benefit Health Services Health Services Accessibility Health Services Research Health Status Health system Healthcare Healthcare Systems Hispanic Impaired cognition Intervention Interview Knowledge Logistic Regressions Los Angeles Measures Medical Medicare Memory Memory Disorders Memory Loss Memory impairment Methods Minority Municipalities Needs Assessment Neurobehavioral Manifestations Not Hispanic or Latino Pathway interactions Patient Self-Report Patients Persons Physicians Population Preventive care Primary Care Process Provider Public Health Reduce health disparities Resources Risk Factors Socioeconomic Status Structure Surveys Symptoms Trust Visit barrier to care beneficiary care delivery care seeking cognitive testing cost dementia care disadvantaged background economic need ethnic minority evidence base experience health care availability health disparity health literacy improved modifiable risk patient population patient subsets psychologic psychosocial racial minority racial minority population response safety net screening shared decision making social stigma socioeconomic disadvantage willingness

项目摘要

Project Summary Early identification of cognitive impairment and dementia is associated with multiple public health benefits and will become even more important if a disease-modifying treatments for Alzheimer’s disease becomes widely available. However, delayed or missed identification of dementia is common, particularly among racial/ethnic minorities and those from socioeconomically disadvantaged backgrounds. Possible explanations for this delay may include patient beliefs about dementia such as it being part of the aging process or fear of associated stigma; conversely, barriers at the level of provider or health-system may hinder timely diagnostic workup. The overall goal of this mixed-methods study is to identify barriers to early identification of dementia for older adults who receive healthcare in a safety net health system. We hypothesize that both patient and health-system level factors are associated with delay in dementia diagnosis within this patient population. We will first determine if the decision to seek evaluation for memory symptoms, assessed through hypothetical clinical scenarios, is associated with a person’s dementia-specific health literacy after adjusting for demographic factors and health status. We will then evaluate if patient self-report of memory symptoms on a state-mandated preventive care visit is associated with a higher likelihood of undergoing diagnostic evaluation for dementia, assessed using a unique electronic health record-derived dataset. We will complement the analytic aims with semi-structured interviews with patients and caregivers to identify barriers to care for memory disorders as well as unmet needs.This study will help identify specific barriers that can be targeted for future interventions to improve early identification of dementia in the safety net population.

项目概要早期识别认知障碍和痴呆症与多种公共健康益处相关，如果阿尔茨海默病的疾病缓解疗法得到广泛应用，这一点将变得更加重要可用的。然而，延迟或漏诊痴呆症的情况很常见，特别是在种族/族裔中少数群体和来自社会经济弱势群体的群体。这种延迟的可能解释可能包括患者对痴呆症的看法，例如它是衰老过程的一部分或对相关疾病的恐惧柱头;相反，提供者或卫生系统层面的障碍可能会阻碍及时的诊断检查。这项混合方法研究的总体目标是确定早期识别痴呆症的障碍对于在安全网卫生系统中接受医疗保健的老年人。我们假设两个患者卫生系统层面的因素与该患者群体中痴呆症诊断的延迟有关。我们将首先确定是否决定寻求记忆症状评估，通过假设进行评估临床情景，与一个人在调整后的痴呆症特定健康素养有关人口因素和健康状况。然后，我们将评估患者是否自我报告记忆症状国家规定的预防性护理就诊与接受诊断评估的可能性较高相关对于痴呆症，使用独特的电子健康记录衍生数据集进行评估。我们将补充分析目标是对患者和护理人员进行半结构化访谈，以确定护理障碍记忆障碍以及未满足的需求。这项研究将有助于确定可针对的特定障碍未来采取干预措施，以改善安全网人群中痴呆症的早期识别。