Potential New Barriers to Home Health Access for People with Alzheimer's Disease and Related Dementias

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PROJECT SUMMARY/ABSTRACT Candidate: I am an assistant professor in the Division of Physical Therapy in the College of Health Professions at the Medical University of South Carolina in Charleston, South Carolina. My long-term goal is to become a well-funded, independent researcher investigating post-acute care of individuals with Alzheimer’s Disease and Related Dementias (ADRD). To achieve this goal, I will build upon my clinical expertise and current research training. For the K01 period, I have set four short term training goals/objectives: (1) Develop competence in post-acute care policy impacting people with ADRD, (2) Develop skills in management and manipulation of Medicare data of people with ADRD, (3) Develop competence in propensity score methods and data analysis for data of people with ADRD, and (4) Enhance my grantsmanship, ethical conduct of research, and mentorship skills for career development and advancement. Mentoring Team: My Primary Mentor is Kit Simpson, DrPH and my Co-Mentor is Kenneth Ottenbacher, PhD, OTR. Additional members of the mentoring team include Annie Simpson PhD, Jacobo Mintzer, MD, MBA, and Kathryn H Bowles PhD, RN, FAAN, FACMI. My mentoring team is highly qualified and includes nationally and internationally recognized experts in health services research (K. Simpson), post-acute care quality measures (K. Ottenbacher), ADRD (J. Mintzer), study design and analysis methods for observational studies (A. Simpson), and home health practice, policy, and research (K. Bowles). My mentoring team will guide career development activities and participate in the K01 research. Research Strategy: Medicare home health underwent unprecedented changes in 2020 due to the COVID-19 pandemic and a new payment model. These vast changes threaten to exacerbate existing barriers to home health access for people with ADRD. Decreased access to home health causes harm to people with ADRD and can trigger a cascade of resource and financial implications for the health care system. Impacts of the current crisis on home health access and quality for people with ADRD has not been examined but is urgently needed. This K01 project will use well matched groups, to show the impact of reimbursement change and pandemic disruption on home health access and outcomes for people with and without ADRD through analysis of Medicare assessment and billing data. Propensity score methods will be used to balance patient risk factors for comparison groups. Aim 1: Describe differences in home health access and outcomes between well- matched groups of Medicare Beneficiaries (MBs) with and without ADRD in 2019. Aim 2: Examine changes in home health access and outcomes for well-matched groups of MBs in 2019 vs 2020. Aim 3: Examine changes in home health access and outcomes for well-matched groups of MBs in 2019 vs 2021. Findings from this study can help to optimize access, cost, and outcomes for people with ADRD and the Medicare system and inform advocacy efforts, current home health practice, and future post-acute care policies.