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

医院和社区护理协调对有 ADRD 危险因素或诊断的个人的医疗保健获取、质量和公平性的影响

• 批准号: 9789164
• 负责人: Jie Chen
• 金额: $ 34.61万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789164
• 关键词: Address; Adult; Affect; African American; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Area; Caring; Cholesterol; Chronic Care; Chronic Disease; Cognitive; Communities; Community Hospitals; Continuity of Patient Care; Critical Care; Data; Data Set; Databases; Dementia; Diabetes Mellitus; Diagnosis; Disease; Disease Progression; Elderly; Ensure; Face; Goals; Health; Health Promotion; Health system; Healthcare; Healthcare Systems; Hispanics; Homelessness; Hospitals; Housing; Hypertension; Improve Access; Individual; Information Systems; Investments; Latino; Life Style; Link; Literature; Longitudinal Studies; Medicare; Medicare claim; Minority; Mission; Obesity; Organizational Models; Outcome; Patients; Policy Maker; Population; Primary Health Care; Public Health; Quality of Care; Research; Resources; Risk Factors; Savings; Services; Smoking; Social Environment; Surveys; System; Time; U.S. Department of Housing and Urban Development; Underserved Population; Variant; base; beneficiary; care coordination; cost; cost effective; data sharing; dementia care; dementia risk; disorder control; economic incentive; effective care management; ethnic minority population; experience; financial incentive; health care availability; health care quality; health disparity; improved; innovation; interest; mild cognitive impairment; modifiable risk; multidisciplinary; neglect; organizational structure; personalized care; personalized health care; population health; preference; programs; racial and ethnic disparities; racial minority; socioeconomics

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.

概括 人口不平等，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） 与老年白人相比，患有阿尔茨海默病和相关痴呆症（ADRD）的可能性明显更高 相同的年龄范围。延迟获得及时的初级保健、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。 医疗保健协调，例如慢性病护理管理和出院后连续性护理 计划已被确定为提高护理质量和患者体验的关键组成部分。在 此外，还提议成立责任医疗组织 (ACO)，通过以下方式促进护理协调： 基于团队的方法和财务激励。然而，人们对这些系统级护理如何进行知之甚少。 协调战略改善了 ADRD 人群的医疗保健获取、质量和公平性。这 我们项目的目标是确定最佳的医院-社区护理协调实践，以改善 有效管理 ADRD 和共存病症；控制/减少 ADRD 的可改变风险因素和 在这些疾病的早期阶段进行医疗保健；并最终促进人口健康并减少 健康差异。我们的主要假设是整合医院和社区护理可以提高质量 ADRD 患者以及 ADRD 风险增加的认知健康老年人之间的公平性。 我们将利用全面的全国护理协调数据，构建多层次的数据集 （个人、医院/ACO、社区和州级）通过链接医疗保险索赔数据和共享储蓄 对责任医疗组织数据进行编程来解决我们的主要假设。使用人口水平 纵向研究（2012-2018），我们的目的是确定护理协调实践和 ACO 对 ADRD 患者和 ADRD 风险较高的老年人的医疗保健获取、质量和费用 （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到达的地区之一的影响 人口：接受联邦住房援助的种族和族裔少数群体（他们可能有 经历过无家可归的时期）（目标 3）；并强调护理协调实践和 ACO 模型 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 我们确定最重要的护理协调实践，这些实践将对增加 对少数 ADRD 患者进行有效护理；并在 ADRD 患者的早期阶段控制疾病 风险因素。我们的结果将为政策制定者提供有关如何利用现有资源的关键信息 将护理协调整合到整个医疗保健系统中，以确保少数群体能够获得最多的服务 适当且有效的护理。该目标与解决阿尔茨海默氏病的国家计划一致 旨在提高护理质量和效率。