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

阿尔茨海默病和相关痴呆症(ADRD)被认为是最昂贵的健康疾病之一。 ADRD患者有更多的急诊科就诊、住院、门诊护理敏感性 住院、再入院、有技能的疗养院住宿和家庭健康访问与没有 ADRD诊断。患有ADRD的种族和少数民族面临着不协调和低质量的高风险 护理，包括更高的住院率、可预防的住院、可避免的急诊科 就诊和医疗保健支出。以医院为基础的健康信息技术(以下简称医院HIT) 越来越多地被用于支持护理协调、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，该框架描述了 医院感染及其在ADRD患者护理中的应用。我们的初步发现进一步证明了 这种由HIT支持的护理可以在ADRD人群中有效地发挥作用。关键是要实现更强大的 医院受灾对卫生服务质量和公平性影响的分析和综合评价 针对ADRD患者不断变化的需求，在设计和实施HIT时向政策制定者提供信息 (和他们的照顾者)随着痴呆症的进展。此外，新冠肺炎大流行不成比例地 受影响的ADRD患者，特别是少数族裔。然而，医院袭击的影响 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 新冠肺炎大流行之前、期间和之后的十年纵向数据集，并通过应用尖端技术 计量经济学模型，这项研究旨在系统地评估医院袭击对医疗质量的影响 以及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；这些影响将在 种族和少数民族患者在获得高质量医疗服务方面面临巨大障碍。具体来说，我们 建议评估医院袭击对医疗质量的影响(即减少再入院、可预防的ED 就诊和可预防的住院)(目标1)，估计医院袭击减少种族的程度 老年人口ADRD的保健质量和支出的种族差异(目标2)； 估计大流行期间医院受灾对健康结果和质量的影响程度(目标 3)。基于针对ADRD患者的HIT-结构性种族主义和歧视框架，我们希望我们的 结果量化医院冲击对ADRD患者医疗质量的影响，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。结果显示 大流行期间医院疫情的影响将提高人们对如何利用医院疫情 在大流行期间协调对ADRD患者的护理。

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.