Annual wellness visit policy: Impact on disparities in early dementia diagnosis and quality of healthcare for Medicare beneficiaries with Alzheimer's Disease and Its Related Dementias

年度健康就诊政策：对患有阿尔茨海默病及其相关痴呆症的医疗保险受益人的早期痴呆诊断和医疗质量差异的影响

• 批准号: 10729272
• 负责人: Yong-Fang Kuo
• 金额: $ 40.99万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729272
• 关键词: Address; Adopted; Adoption; Advance Care Planning; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Attention; Black American; Caring; Cognition; Communities; Consultations; Credentialing; Data; Data Analyses; Data Collection; Data Linkages; Data Scientist; Dementia; Development; Diagnosis; Disadvantaged; Disparity; Elderly; Ensure; Ethnic Origin; Ethnic Population; Evaluation; Exposure to; Fall prevention; Family Caregiver; Family Practice; Fracture; Friends; Health; Health Policy; Health Services; Health system; Healthcare; High Prevalence; Hispanic; Hispanic Americans; Impaired cognition; Independent Living; Internal Medicine; International; Internist; Interview; Link; Medicare; Mental Depression; Methods; Nurse Practitioners; Nurses; Outcome; Patients; Persons; Pharmaceutical Preparations; Physical environment; Physicians; Policies; Practice Guidelines; Preventive service; Primary Care; Race; Random Allocation; Recommendation; Reduce health disparities; Rehabilitation therapy; Research Design; Research Personnel; Retirement; Risk Assessment; Rural; Sampling; Scientist; Self Care; Sex Differences; Social Work; Socioeconomic Status; Surveys; Telephone; Texas; United States Centers for Medicare and Medicaid Services; Visit; Woman; Work; acute care; beneficiary; black men; black women; cost; dementia care; disparity reduction; ethnic difference; fall risk; falls; family caregiving; health care quality; health care service; health disparity; high risk; improved; individualized prevention; interest; men; outcome disparities; prevent; racial difference; racial population; research study; sex; socioeconomics; sound; trend; urban residence

PROJECT SUMMARY/ABSTRACT Early recognition of cognitive impairment and timeliness in Alzheimer’s Disease and Related Dementias (ADRD) diagnoses are key to optimal dementia care. Data show that early ADRD recognition is linked to less exposure to potentially inappropriate medications (PIM), less propensity for acute care use, lower rates of falls, and increased adoption of advance care planning. One potential way to improve early recognition of ADRD is Annual Wellness Visits (AWVs)—a free preventive service that covers cognition and fall risk assessment, medication reconciliation, and personalized prevention plans. The Centers for Medicare & Medicaid Services (CMS) began reimbursing AWVs in 2011. The Alzheimer’s Association (AA) has drawn attention to the higher prevalence and risk of ADRD among women than men and black and Hispanic Americans than whites. Receipt of AWVs might decrease health disparities; however, evidence to date is inconsistent. This 5-year R01 project has a focus on community-dwelling ADRD patients and is based on the Institute for Healthcare Improvement’s 4Ms framework of an age-friendly health system, 4Ms: what matters, mentation, mobility, and medication. We will conduct a convergent parallel mixed-methods design research study to assess the effect of AWV policy on early ADRD diagnosis and reducing health disparities. We will analyze national Medicare data, health retirement survey-Medicare linkage data, and National Health & Aging Trends study-Medicare linkage data to understand the effect of AWV implementation on reducing health disparities across sex, racial/ethnic, socioeconomic status, and rural/urban residence. Also, we will collect primary data (phone interviews) from 180 family caregivers of ADRD patients (~30 in each of the 6 groups: Hispanic men, Hispanic women, black men, black women, white men, and white women) and 400 clinicians (~100 in each of 4 Medicare regions, ~25 in each of 4 credential areas: family medicine, internal medicine primary care, geriatricians, nurse practitioners) to understand how AWV is delivered to ADRD patients in order to identify the potential mechanism for reducing health disparity through AWV. For family caregivers, we will use a snowball sampling method with AA’s and Rotary International networks, and AA’s TrialMatch® platform to reach potential subjects nationwide. For clinicians, we will randomly select clinicians nationwide from the 2019 CMS doctors and clinicians national file. We will partner with AA to ensure sound data collection and development of practical implications to inform policy/practice. Our three specific aims are: Aim 1: Assess the effects of AWV on the timeliness of ADRD diagnosis (mentation); Aim 2: Assess the effects of AWV on advance care planning consultation (what matters), depression (mentation), fall and fracture (mobility), and PIM use and ADRD treatment (medication) for ADRD patients across sex, racial/ethnic, socioeconomic status, and rural/urban residence; and Aim 3: Identify what works and what does not work in AWV delivery for ADRD patients.

项目总结/摘要 阿尔茨海默病及相关痴呆患者认知功能损害的早期识别和及时性 ADRD诊断是最佳痴呆症护理的关键。数据显示，早期ADRD识别与较少的 暴露于潜在不适当的药物（PIM），急性护理使用倾向较低，福尔斯发生率较低， 并增加了对提前护理计划的采用。提高ADRD早期识别的一种潜在方法是 年度健康访问（AWV）-一项免费的预防服务，包括认知和跌倒风险评估， 药物协调和个性化预防计划。医疗保险和医疗补助服务中心 (CMS)2011年开始报销AWV。老年痴呆症协会（AA）已经引起了人们对老年痴呆症的关注。 女性ADRD的患病率和风险高于男性，黑人和西班牙裔美国人高于白人。收据 AWV可能会减少健康差距;然而，迄今为止的证据是不一致的。 这个为期5年的R 01项目的重点是社区居住的ADRD患者， 医疗保健改善的4 M框架的一个年龄友好的卫生系统，4 M：什么是重要的，心理， 移动性和药物。我们将进行一项收敛并行混合方法设计研究， 评估AWV政策对早期ADRD诊断和减少健康差异的影响。我们将分析 国家医疗保险数据、健康退休调查-医疗保险关联数据和国家健康与老龄化趋势 研究-医疗保险关联数据，以了解AWV实施对减少健康差距的影响 性别、种族/民族、社会经济地位和城乡居住地。我们还将收集原始数据 （电话采访）来自180名ADRD患者的家庭照顾者（6组中每组约30人：西班牙裔男性， 西班牙裔女性、黑人男性、黑人女性、白色男性和白色女性）和400名临床医生（ 4个医疗保险地区，4个认证领域各25个：家庭医学，内科初级保健， 老年病学家、执业护士）了解AWV是如何输送给ADRD患者的， 通过AWV减少健康差距的潜在机制。对于家庭照顾者，我们将使用雪球 通过AA和Rotary International网络以及AA的TrialMatch®平台， 全国范围内的潜在目标。对于临床医生，我们将从2019年CMS中随机选择全国范围内的临床医生 医生和临床医生国家档案。我们将与机管局合作，确保妥善收集数据， 为政策/实践提供信息的实际影响。我们的三个具体目标是： 目的1：评估AWV对ADRD诊断及时性（精神状态）的影响; 目的2：评估AWV对提前护理计划咨询（重要的是）、抑郁症 （精神状态）、跌倒和骨折（活动性）以及PIM使用和ADRD治疗（药物） 患者的性别、种族/民族、社会经济地位和农村/城市居住地;以及 目的3：确定ADRD患者AWV输送中哪些有效，哪些无效。