The effect of medical school, residency program, and health system board diversities on racial and ethnic disparities in AD/ADRD care.

项目摘要 在阿尔茨海默病和阿尔茨海默病的整个病程中提供高质量的护理- 相关性痴呆（AD/ADRD）已被证明与更好的生活质量，更少的照顾者 痛苦，减少急性和长期护理的使用。然而，在种族和族裔方面属于少数群体的人， AD/ADRD患者通常接受比白色患者更差的质量护理，包括更低的进展率 指令，减少抗痴呆症药物的接收，增加临终住院治疗。虽然 政府和机构政策影响医学教育/培训和工作中的R&E多样性 在环境中，人们对医学教育、住院医师培训和健康领域的研发多样性知之甚少 系统领导影响AD/ADRD护理中R&E差异。这一知识差距阻碍了 制定干预措施，可以有效地消除AD/ADRD护理的差异。拟定的研究将 通过将准实验方法应用于全面的 我们将开发有关患者、医生、医学院、住院医师计划和卫生系统的数据， 连接7个具有全国代表性的数据库（医疗保险索赔数据、消费者医疗保健评估 供应商和系统数据，Doximity医生数据，美国医学院协会医学 学校数据、美国医学会住院医师项目数据、兰德健康系统数据，以及 美国医院协会国家卫生保健管理调查数据）。在目标1中，我们将确定 从医学院校毕业的医生的R&E多样性对差异的影响 在AD/ADRD护理中，通过应用准实验工具变量方法，使用状态肯定 作为一种工具的行动禁令。州平权行动禁令是一个理想的工具，因为它们是 与医学院学生身体多样性密切相关，但不直接影响AD/ADRD护理。在 目标2，我们将确定4个住院医师项目特征的效果（住院医师的R&E多样性较高， 存在文化能力意识计划、医学西班牙语或其他非英语教学 语言，以及在县和安全网医院的轮换）对AD/ADRD护理的R&E差异，使用 倾向评分匹配法在目标3中，我们将确定卫生系统R&E多样性的效果 在AD/ADRD护理的差异板，通过应用倾向评分匹配方法。该项目将 为决策者制定政策干预措施提供强有力的证据基础（例如，增加R&E多样性 并在医学院、住院医师项目中引入文化能力意识项目， 卫生系统），可以有效地减轻AD/ADRD护理的R&E差距。研究团队由 研究人员在所有相关领域（阿尔茨海默病和痴呆症研究，R&E差距）的专业知识 研究、医学教育和培训、组织行为、医生和卫生系统绩效， 以及计量经济学和统计学方法）进行这项创新研究。

Project Summary High-quality care throughout the trajectory of illness of Alzheimer's disease and Alzheimer's disease- related dementias (AD/ADRD) has been shown to be associated with a better quality of life, lower caregiver distress, and reduced use of acute and long-term care. However, racial and ethnic (R&E) minoritized persons with AD/ADRD often receive poorer quality care than White patients, including lower rates of advance directives, reduced receipt of anti-dementia medications, and increased end-of-life hospitalizations. Although governmental and institutional policies influence R&E diversity in medical education/training and work environments, little is known about how R&E diversity in medical education, residency training, and health system leadership affect R&E disparities in AD/ADRD care. This knowledge gap has hindered efforts to develop interventions that could effectively eliminate disparities in AD/ADRD care. The proposed study will address these important knowledge gaps by applying the quasi-experimental methods to the comprehensive data on patients, physicians, medical schools, residency programs, and health systems we will develop by linking 7 nationally-representative databases (Medicare Claims Data, Consumer Assessment of Healthcare Providers and Systems Data, Doximity Physician Data, Association of American Medical Colleges Medical School Data, American Medical Association Residency Program Data, RAND Health System Data, and American Hospital Association National Health Care Governance Survey Data). In Aim 1, we will determine the effect of the R&E diversity of medical school student bodies from which physicians graduated on disparities in AD/ADRD care, by applying the quasi-experimental instrumental variable method using the state affirmative action bans as an instrument. The state affirmative action bans serve as an ideal instrument because they are strongly associated with medical school student body diversity, but do not directly affect AD/ADRD care. In Aim 2, we will determine the effect of 4 residency program characteristics (higher R&E diversity of residents, presence of cultural competence awareness program, instruction in medical Spanish or other non-English languages, and rotation at the county and safety-net hospitals) on R&E disparity in AD/ADRD care, using the propensity score matching method. In Aim 3, we will determine the effect of R&E diversity of health system boards on disparities in AD/ADRD care, by applying the propensity score matching method. This project will provide a robust evidence base for policymakers to develop policy interventions (e.g., increasing R&E diversity and introducing the cultural competency awareness program at medical schools, residency programs, and health systems) that could effectively mitigate R&E disparities in AD/ADRD care. The research team consists of investigators with expertise in all relevant fields (Alzheimer's disease and dementia research, R&E disparity research, medical education and training, organizational behaviors, physician and health system performance, and econometric and statistical methods) to conduct this innovative research.