The impact of facility characteristics on racial disparities in ADRD mortality in nursing homes

设施特征对疗养院 ADRD 死亡率种族差异的影响

• 批准号: 10783718
• 负责人: Michelle Anne DeVost
• 金额: $ 3.95万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10783718
• 关键词: Accounting; Adult; Affect; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease care; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Attention; Back; Black race; COVID-19 pandemic; California; Caring; Censuses; Cessation of life; Characteristics; Chronic; Competence; Data; Data Set; Data Sources; Dedications; Detection; Development; Diagnosis; Disparity; Elderly; Epidemiologic Methods; Epidemiology; Ethnic Origin; Excess Mortality; Foundational Skills; Goals; Health Disparities Research; Health Policy; Health Services; Health Services Accessibility; Home Nursing Care; Hour; Inequality; Inequity; Institution; Institutional Racism; Knowledge; Latinx; Link; Mentors; Mentorship; Methodology; Methods; Mission; Modeling; Mortality Determinants; National Research Service Awards; Nurses; Nursing Homes; Persons; Policies; Population; Positioning Attribute; Predisposition; Prevalence; Public Health; Quality of Care; Race; Racial Segregation; Registries; Research; Research Personnel; Risk; Safety; Series; Source; Stress; Structural Racism; Subgroup; System; Time; Training; United States; United States Centers for Medicare and Medicaid Services; Update; Variant; Vulnerable Populations; Work; analytical method; body system; care delivery; career; comorbidity; doctoral student; experience; health care delivery; health equity; health inequalities; health outcome disparity; high risk; human old age (65+); improved; innovation; insight; mortality; mortality disparity; mortality risk; multiple chronic conditions; outcome disparities; pandemic disease; population health; pressure; racial disparity; skills; social; social disparities; social epidemiology; stressor; structural determinants; time use

PROJECT SUMMARY/ABSTRACT This mentored Ruth L. Kirschstein National Research Service Award will provide the trainee, a PhD student in epidemiology at UCSF, necessary training in social inequalities in nursing home (NH) care delivery, determinants of mortality risk for older adults with Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD), and quantitative skills for analyzing and accounting for bias in large administrative datasets. Guided by a team of expert mentors, the trainee will gain the skills, practical experience, and knowledge to launch a successful academic research career dedicated to the application of rigorous epidemiologic methods to study the social systems of aging and health services in the context of ongoing social inequity, health inequality, and institutional and structural racism. The COVID-19 pandemic heightened the burden on NHs and increased variation in facility characteristics including staffing ratios and average nurse hours per resident day. The resulting systemic stress can highlight institutional drivers of long-standing health inequities among NH residents with AD/ADRD by race/ethnicity. While large racial inequalities in excess mortality occurred during the COVID-19 pandemic, the determinants of these inequalities—particularly among NH residents living with AD/ADRD—are not known. Prior studies of excess mortality in NHs have not explored the effects of time-varying, policy-relevant variables like NH occupancy and staffing characteristics. Building on prior work of the trainee, this F31 uses linked administrative datasets including comprehensive mortality data for the state of California and NH facility data from the Centers for Medicare and Medicaid Services to: (Aim 1) estimate pandemic-era excess mortality overall and stratified by race/ethnicity among all NH residents, NH residents with AD/ADRD, and multimorbid NH residents with AD/ADRD, and (Aim 2) identify time-invariant and time-varying facility/staffing characteristics linked to excess mortality and racial disparities in excess mortality in these populations. This analysis will deliver policy- relevant evidence on NH characteristics that put older adults at risk and fulfill the candidate’s training aims to position her for ongoing research to improve the lives of Black and Latinx older adults with AD/ADRD living in NHs. This proposal’s major strengths are: (1) a state-level census of mortality in California dating back to 2016; (2) longitudinal census data of all NH facilities in California over the same period; and (3) innovative hypotheses focusing on gaps in health equity research for highly vulnerable older adults. Knowledge gained from this research will advance the NIA’s mission to identify and evaluate structural factors that produce disparities in quality and access to care in old age. Guided by an exemplary mentorship team, the proposed training will enhance the applicant’s methodological skills, research competency, and content expertise needed for her career as an independent academic researcher focused on improving health equity for older adults.

项目总结/摘要 这是Ruth L. Kirschstein国家研究服务奖将提供实习生，博士生在 流行病学在加州大学旧金山分校，必要的培训，在社会不平等的护理之家（NH）提供， 老年阿尔茨海默病及阿尔茨海默病相关疾病死亡风险的决定因素 痴呆症（AD/ADRD），以及分析和解释大型行政管理中偏见的定量技能 数据集。在专家导师团队的指导下，学员将获得技能，实践经验， 知识展开成功的学术研究生涯，致力于严谨的应用 流行病学的方法来研究社会系统的老龄化和卫生服务的背景下， 社会不平等、健康不平等以及体制和结构性种族主义。 COVID-19大流行加重了NH的负担，并增加了设施特征的变化 包括人手比率及每住院医生日的平均护士时数。由此产生的系统性压力可以突出 NH AD/ADRD居民中长期存在的健康不平等的机构驱动因素，按种族/民族划分。 虽然在COVID-19大流行期间，超额死亡率存在很大的种族不平等，但 这些不平等--特别是在患有AD/ADRD的NH居民中--尚不清楚。以前的研究 NHS中的超额死亡率没有探索时变的、政策相关的变量（如NH）的影响 占用情况和人员配置特点。在学员之前工作的基础上，此F31使用链接的管理 数据集，包括加州州的综合死亡率数据和来自 医疗保险和医疗补助服务中心：（目标1）估计大流行时期的总体超额死亡率， 在所有NH居民、患有AD/ADRD的NH居民和患有多种疾病的NH居民中，按种族/民族分层 与AD/ADRD，以及（目标2）确定与以下相关的时不变和时变设施/人员配置特征 这些人群中的超额死亡率和超额死亡率的种族差异。这一分析将提供政策- NH特征的相关证据，使老年人处于危险之中，并实现候选人的培训目标， 定位她正在进行的研究，以改善黑人和拉丁裔老年人的生活与AD/ADRD生活在 NHS。该提案的主要优势在于：（1）追溯至2016年的加州州一级死亡率普查; (2)加州所有NH设施在同一时期的纵向人口普查数据;以及（3）创新 假设侧重于高度脆弱的老年人健康公平研究的差距。获得的知识 从这项研究中，将推进NIA的使命，即确定和评估产生 在老年人获得护理的质量和机会方面存在差距。在模范导师团队的指导下， 培训将提高申请人的方法技能，研究能力和内容的专业知识需要 作为一名独立的学术研究人员，她的职业生涯专注于改善老年人的健康公平。