Effect of Hospital and Community Care Coordination on Health Care Access, Quality and Equity among Individuals with Risk Factors or Diagnosis of ADRD

摘要 不平等人口，特别是老龄化的非洲裔美国人和西班牙裔美国人(65岁及以上) 在美国，患阿尔茨海默病和相关痴呆症(ADRD)的可能性明显高于年长的白人 同样的年龄范围。获得及时初级保健的延迟、缺乏护理协调以及生活方式的变化 社会经济条件被认为是造成种族和族裔差异的主要因素。 保健协调，例如慢性护理管理和出院后护理的连续性 计划，已被确定为改善护理质量和患者体验的关键组成部分。在……里面 此外，已提议责任护理组织(ACO)通过以下方式促进护理协调 以团队为基础的方法和财务激励。然而，人们对这些系统级护理是如何进行的知之甚少 协调战略改善了ADRD患者获得医疗保健的机会、质量和公平。这个 我们项目的目标是确定最佳的医院-社区护理协调做法，以改善 有效管理ADRD和共存情况；控制/减少ADRD和 在早期阶段对这些疾病进行卫生保健；并最终促进人口健康和减少 健康差距。我们的主要假设是，整合医院和社区护理可以提高质量 ADRD患者和认知健康的老年人之间的公平性，ADRD风险增加。 我们将利用我们全面的、全国性的护理协调数据，并构建一个多层次的数据集 (个人、医院/ACO、社区和州级别)，将Medicare报销数据和共享储蓄联系起来 计划责任关怀组织数据，以解决我们的主要假设。使用人口级别 纵向研究(2012-2018)，我们的目标是确定护理协调做法和ACOs对 ADRD患者和ADRD风险较高的老年人的医疗服务可获得性、质量和成本 (包括患有糖尿病、高血压、高胆固醇、肥胖、吸烟和轻度认知障碍的成年人 损害)(目标1和2)；估计护理协调对最难触及的对象之一的影响 人口：接受联邦住房援助的种族和少数民族人口(可能有 (目标3)；并强调护理协调做法和非政府组织模式 这可以减少种族和民族差异(目标4)。我们的多学科、基于系统的方法将使 美国将确定最关键的护理协调做法，这些做法将对增加 对少数民族ADRD患者进行有效护理；对ADRD患者进行早期疾病控制 风险因素。我们的结果将为决策者提供如何利用现有资源的关键信息 整合整个卫生保健系统的护理协调，以确保少数群体能够获得最多的 适当和有效的护理。这一目标与应对阿尔茨海默氏症的国家计划一致 旨在提高护理质量和效率。

SUMMARY Disparity populations, in particular aging African-Americans and Hispanics (65 years and older), are significantly more likely to have Alzheimer’s disease and related dementia (ADRD) than older Whites in the same age range. Delays in accessing timely primary care, lack of care coordination, and variations in lifestyle and socioeconomic conditions are considered as major factors that contribute to racial and ethnic disparities. Health care coordination, such as chronic care management and post-hospital discharge continuity of care programs, has been identified as a critical component in improving quality of care and patient experience. In addition, Accountable Care Organizations (ACOs) have been proposed to promote care coordination through team-based approaches and financial incentives. However, little is known about how these system-level care coordination strategies have improved health care access, quality and equity for populations with ADRD. The objective of our project is to determine best hospital-community care coordination practices that can improve effective management of ADRD and co-existing conditions; control/reduce modifiable risk factors of ADRD and administer health care for these diseases in early stages; and eventually promote population health and reduce health disparities. Our primary hypothesis is that integrating hospital and community care can improve quality and equity among people with ADRD as well as cognitively healthy older adults at increased risk for ADRD. We will leverage our comprehensive, national data on care coordination, and construct a multi-level data set (individual-, hospital/ACO-, community-, and state- level) by linking Medicare claims data and Shared Savings Program Accountable Care Organizations data to address our primary hypothesis. Using a population-level longitudinal study (2012-2018), we aim to identify the influences of care coordination practices and ACOs on health care access, quality, and cost for people with ADRD and older adults at increased risk for ADRD (including adults living with diabetes, hypertension, high cholesterol, obesity, smoking, and mild cognitive impairment) (Aims 1 and 2); estimate the impact of care coordination on one of the hardest-to-reach populations: racial and ethnic minority populations who received federal housing assistance (who may have experienced periods of homelessness) (Aim 3); and highlight care coordination practices and the ACO models that can reduce racial and ethnic disparities (Aim 4). Our multidisciplinary, systems-based approach will enable us to identify the most critical care coordination practices that will have the greatest impact on increasing effective care for minority patients with ADRD; and control diseases in early stages among those with ADRD risk factors. Our results will provide policy makers with critical information on how to utilize existing resources to integrate care coordination across the health care system to ensure that minorities get access to the most appropriate and effective care. The goal aligns with the National Plan to Address Alzheimer's Disease that aims to enhance care quality and efficiency.