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

项目概要 贯穿阿尔茨海默病和阿尔茨海默病整个疾病轨迹的高质量护理- 相关痴呆症（AD/ADRD）已被证明与更好的生活质量、更少的照顾者有关 痛苦，并减少急性和长期护理的使用。然而，种族和族裔 (R&E) 少数群体 AD/ADRD 患者通常接受的护理质量比白人患者差，包括提前率较低 指令、抗痴呆药物的接受减少以及临终住院治疗的增加。虽然 政府和机构政策影响医学教育/培训和工作中的研究与教育多样性 人们对医学教育、住院医师培训和健康领域的 R&E 多样性如何了解知之甚少 系统领导力影响 AD/ADRD 护理中的 R&E 差异。这种知识差距阻碍了努力 制定可有效消除 AD/ADRD 护理差异的干预措施。拟议的研究将 通过将准实验方法应用于综合研究来解决这些重要的知识差距 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 个全国代表性数据库（医疗保险索赔数据、消费者医疗保健评估） 提供商和系统数据、Doximity 医师数据、美国医学院协会医学 学校数据、美国医学会住院医师计划数据、兰德健康系统数据以及 美国医院协会国家医疗保健治理调查数据）。在目标 1 中，我们将确定 医生毕业的医学院学生群体的研究与教育多样性对差异的影响 在 AD/ADRD 护理中，通过使用状态肯定应用准实验工具变量方法 行动禁令作为一种工具。国家平权行动禁令是一种理想的工具，因为它们 与医学院学生群体多样性密切相关，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影响（住院医师更高的 R&E 多样性、 存在文化能力意识计划、医学西班牙语或其他非英语教学 AD/ADRD 护理中的 R&E 差异，使用 倾向得分匹配法。在目标 3 中，我们将确定卫生系统 R&E 多样性的影响 通过应用倾向评分匹配方法，委员会讨论了 AD/ADRD 护理方面的差异。该项目将 为政策制定者制定政策干预措施提供强有力的证据基础（例如，增加研究和教育多样性 并在医学院、住院医师培训计划中引入文化能力意识计划，以及 卫生系统），可以有效减少 AD/ADRD 护理中的 R&E 差异。研究团队组成 拥有所有相关领域专业知识的研究人员（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.