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 高质量的护理贯穿于阿尔茨海默病和阿尔茨海默病的患病轨迹-- 相关痴呆症(AD/ADRD)已被证明与更好的生活质量、更低的照顾者相关 痛苦，减少对急性和长期护理的使用。然而，种族和民族(R&E)使人成为少数人 患有AD/ADRD的患者得到的护理质量往往比白人患者差，包括进展率较低 指令，减少接受抗痴呆症药物治疗，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R&E的多样性 环境，对R&E在医学教育、住院医师培训和健康方面的多样性知之甚少 系统领导力影响AD/ADRD护理中的R&E差异。这一知识鸿沟阻碍了 制定干预措施，有效消除AD/ADRD护理方面的差异。拟议的研究将 通过应用准实验方法解决这些重要的知识差距 关于患者、医生、医学院、住院医生计划和卫生系统的数据，我们将通过 链接7个具有全国代表性的数据库(Medicare索赔数据、医疗保健消费者评估 提供者和系统数据，Doximity医生数据，美国医学院医学协会 学校数据、美国医学会住院医生计划数据、兰德健康系统数据和 美国医院协会全国卫生保健治理调查数据)。在目标1中，我们将确定 内科医生毕业的医学院学生群体R&E多样性对差异的影响 在AD/ADRD CARE中，通过使用状态肯定的准实验工具变量方法 作为一种手段，行动被禁止。州平权行动禁令是一种理想的工具，因为它们 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……里面 目标2，我们将确定4个住院医生计划特征的影响(居民的R&E多样性较高， 有文化能力意识计划，医学西班牙语或其他非英语教学 语言、县医院和安全网医院的轮换)对AD/ADRD护理中R&E差异的影响，使用 倾向性得分匹配法。在目标3中，我们将确定卫生系统R&E多样性的影响 通过应用倾向得分匹配方法，对AD/ADRD护理方面的差异进行公告。这个项目将 为政策制定者制定政策干预措施(例如，增加R&E多样性)提供强有力的证据基础 并在医学院引入文化能力意识计划，住院医生计划，以及 可以有效地减少AD/ADRD护理中的R&E差距。研究小组由以下人员组成 拥有所有相关领域专业知识的调查人员(阿尔茨海默病和痴呆症研究、R&E差异 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方法)来进行这项创新研究。

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.