The impact of hospital-based health information technology on health care quality and equity among patients with ADRD

基于医院的卫生信息技术对 ADRD 患者医疗保健质量和公平性的影响

• 批准号: 10729695
• 负责人: Jie Chen
• 金额: $ 193.36万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729695
• 关键词: Adult; Aging; Alzheimer' s disease care; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Ambulatory Care; COVID-19; COVID-19 pandemic; Caregivers; Caring; Communities; Complex; Contracts; Cost Savings; Dementia; Diagnosis; Discrimination; Econometric Models; Emergency Situation; Emergency department visit; Equity; Expenditure; Family member; Health; Health Expenditures; Healthcare; Healthcare Systems; Home; Hospitalization; Hospitals; Individual; Infrastructure; Investments; Mission; Modeling; Outcome; Outpatients; Patients; Persons; Policy Maker; Population; Provider; Public Health; Quality of Care; Reduce health disparities; Research; Resources; Role; Services; Social Work; Structural Racism; Systems Integration; Time; Underserved Population; Visit; Vulnerable Populations; Work; aging population; care coordination; combat; community engagement; cost; cost estimate; data integration; design; digital technology; electronic data; ethnic disparity; ethnic health disparity; ethnic minority; ethnic minority population; evidence base; health care quality; health equity; health information technology; high risk; hospital readmission; hospitalization rates; improved; longitudinal dataset; minority patient; nursing home length of stay; nursing skill; pandemic disease; patient engagement; payment; post-COVID-19; racial disparity; racial minority; racial minority population; social health determinants; telehealth; treatment services

Alzheimer's disease and related dementia (ADRD) is considered one of the most expensive health conditions. Patients with ADRD have more emergency department visits, hospitalizations, ambulatory care sensitivity hospitalization, readmissions, skilled nursing home stays, and home health visits compared to adults without an ADRD diagnosis. Racial and ethnic minorities with ADRD are at high risk for uncoordinated and low-quality care, including higher rates of hospitalizations, preventable hospitalization, avoidable emergency department visits, and health care expenditures. Hospital-based health information technology (hereinafter “hospital-HIT”) is increasingly being used to support care coordination, advance patient engagement, and improve health information exchange. Our team has developed a conceptual framework that delineates the critical roles of hospital-HIT and its application in the care of ADRD patients. Our preliminary findings further show evidence that HIT-supported care can work effectively in ADRD populations. It is critical to implement more robust analyses and comprehensive assessments of the impact of hospital-HIT on health care quality and equity to inform policymakers in the design and implementation of HIT, across the changing needs of ADRD patients (and their caregivers) as dementia progresses. In addition, the COVID-19 pandemic has disproportionately impacted patients with ADRD, especially racial and ethnic minorities. However, the impact of hospital-HIT on health outcomes and equity for persons with ADRD during the pandemic is still lacking. Hence, through the use of ten-year longitudinal dataset before, during, and post the COVID-19 pandemic, and by applying cutting-edge econometric models, this study aims to systematically assess the impact of hospital-HIT on health care quality and equity of patients with ADRD, including the health outcomes during the pandemic. We hypothesize that hospital-HIT that aims to promote care coordination, patient engagement, and data integration can improve health care quality and reduce health care expenditure; and that these impacts will be more pronounced for racial and ethnic minority patients who face substantial barriers to accessing high-quality care. Specifically, we propose to evaluate the impact of hospital-HIT on health care quality (i.e., reduce readmission, preventable ED visits, and preventable hospitalizations) (Aim 1), estimate the extent to which hospital-HIT has reduced racial and ethnic disparities of health care quality and expenditures for the aging population with ADRD (Aim 2); and estimate the extent to which hospital-HIT has impacted health outcomes and quality during the pandemic (Aim 3). Grounded in the HIT-Structural Racism and Discrimination framework for ADRD patients, we expect our results to quantify the impact of hospital-HIT on health care quality for patients with ADRD, including those from racial and ethnic minority groups and communities with different social determinants of health. Results on the impact of hospital-HIT during the pandemic will improve the understanding of how to use hospital-HIT to coordinate care for people with ADRD during the pandemic.

阿尔茨海默病和相关痴呆症（ADRD）被认为是最昂贵的健康状况之一。 ADRD患者有更多的急诊就诊、住院、门诊护理敏感性 住院，再入院，熟练的护理之家住宿和家庭健康访问相比，成人没有 ADRD诊断患有ADRD的种族和少数民族面临不协调和低质量的高风险 护理，包括提高住院率、可预防的住院、可避免的急诊 访问和医疗保健支出。基于医院的健康信息技术（以下简称“医院-HIT”） 越来越多地用于支持护理协调、促进患者参与和改善健康 信息交流。我们的团队已经开发了一个概念框架，描述了 医院HIT及其在ADRD患者护理中的应用。我们的初步调查结果进一步表明 HIT支持的护理可以在ADRD人群中有效发挥作用。至关重要的是， 分析和综合评估医院HIT对医疗保健质量和公平性的影响， 告知决策者HIT的设计和实施，以及ADRD患者不断变化的需求 (and他们的照顾者）随着痴呆症的进展。此外，COVID-19大流行也造成了不成比例的影响 影响ADRD患者，尤其是少数种族和民族。然而，医院HIT对 在大流行期间，ADRD患者的健康结果和公平仍然缺乏。因此，通过使用 在COVID-19大流行之前，期间和之后的十年纵向数据集，并通过应用最先进的 本研究的目的是系统地评估医院HIT对医疗服务质量的影响 和ADRD患者的公平性，包括大流行期间的健康结果。我们假设 旨在促进护理协调、患者参与和数据集成的医院HIT可以改善 卫生保健质量和减少卫生保健支出;这些影响将更加明显， 种族和少数民族患者在获得高质量护理方面面临巨大障碍。我们特别 建议评估医院HIT对医疗保健质量的影响（即，减少再入院，可预防的艾德 访问和可预防的住院治疗）（目标1），估计医院HIT减少种族歧视的程度。 以及患有ADRD的老龄化人口的医疗保健质量和支出的种族差异（目标2）;以及 估计大流行期间医院HIT对健康结果和质量的影响程度（Aim 3）。基于对ADRD患者的HIT-结构性种族主义和歧视框架，我们希望我们的 结果量化医院HIT对ADRD患者医疗保健质量的影响，包括 来自具有不同健康社会决定因素的种族和少数民族群体和社区。结果 大流行期间医院HIT的影响将提高对如何使用医院HIT的理解， 在大流行期间协调对ADRD患者的护理。