The Impact of physician and health system factors on the quality of care for persons with Alzheimer's disease and related dementias at the end of life

医生和卫生系统因素对阿尔茨海默病和相关痴呆症患者临终护理质量的影响

• 批准号: 10032518
• 负责人: Yusuke Tsugawa
• 金额: $ 49.43万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10032518
• 关键词: Academic Medical Centers; Address; Admission activity; Advance Care Planning; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Big Data; Caregiver support; Caring; Cessation of life; Characteristics; Clinical; Clinical Research; Data; Data Set; Database Management Systems; Databases; Family; Fellowship; Funding; Geriatrics; Health Services Research; Health system; Hospitals; Incentives; Individual; Intensive Care Units; Interdisciplinary Study; Intervention; Knowledge; Life; Link; Malignant Neoplasms; Measures; Mechanical ventilation; Medicare; Medicare claim; Methods; Palliative Care; Patient-Focused Outcomes; Patients; Performance; Persons; Physicians; Play; Policies; Population; Positioning Attribute; Process; Quality of Care; Quality of life; Research; Research Personnel; Residencies; Role; Sampling; Socioeconomic Status; Structure; Symptoms; Terminally Ill; Testing; Training; Training and Education; Translational Research; United States National Institutes of Health; Variant; aggressive therapy; cognitive ability; dementia care; design; end of life; end of life care; evidence base; experience; financial incentive; hospice environment; improved; innovation; medical specialties; novel strategies; palliative; programs; sex; systems research; therapy design

Project Summary Evidence indicates that individuals with Alzheimer's disease and related dementias (ADRD) often receive suboptimal care at the end of life (EOL). Although patient factors (e.g., socioeconomic status, caregiver support) clearly affect the quality of EOL care, studies also demonstrate wide variations in how physicians and health systems treat terminally-ill patients. However, existing studies on the quality of palliative and EOL care have been focused primarily on patients with cancer, and evidence is limited as to the quality of EOL care for persons with ADRD. Indeed, little is known about physician and health system factors that are associated with the quality of palliative and EOL care for persons with ADRD. These knowledge gaps have hindered efforts to develop interventions that can effectively improve the quality of EOL care for persons with ADRD. The proposed R01 will create a comprehensive, multi-level database that includes detailed information about patients, physicians, and health systems, by linking three large, nationally-representative datasets: (1) Medicare claims data (patient factors), (2) Doximity Physician Database (physician factors), and (3) RAND Health System Database (health system factors). In Aim 1, using this innovative database, we will identify physician factors (e.g., age, sex, clinical experience, specialty, residency and fellowship training in geriatrics and/or palliative care) that are associated with the quality of EOL care (defined as (1) the receipt of advance care planning, palliative care, and hospice, (2) aggressiveness of EOL care, and (3) patient outcomes) for persons with ADRD. In Aim 2, we will identify health system factors (e.g., academic medical centers, profit status, size, region, ACO status) associated with the quality of EOL care for persons with ADRD. In Aim 3, focusing on physicians who practice at multiple health systems (about 21% of physicians practice at multiple health systems), we will investigate whether health system factors influence physicians' aggressiveness of EOL care for persons with ADRD. The proposed R01 will provide a unique opportunity to advance the field by better understanding the mechanisms of how physicians and health systems affect the quality of EOL care provided to persons with ADRD, with a special focus on mutable physician factors (e.g., education and training in geriatrics and/or palliative care) and health system factors (e.g., financial incentives) that contribute to the quality of EOL care. This project will provide a strong evidence base for developing interventions (e.g., CME for physicians targeted at palliative and EOL care for persons with ADRD, financial incentives for ACOs), which can effectively improve the quality of care for persons with ADRD at the EOL. The research team consists of multiple NIH-funded researchers with expertise in all relevant fields (health services research using big data, Alzheimer's disease and dementia research, palliative and EOL care research, and health system research) to conduct this innovative research. The proposed study aligns well with the NIA's FOA to address clinical and translational research gaps to improve quality EOL care for people with ADRD and their families.

项目摘要 有证据表明，阿尔茨海默病和相关痴呆症（ADRD）患者经常接受 生命末期（EOL）的次优护理。虽然患者因素（例如，社会经济地位，照顾者 支持）明显影响EOL护理的质量，研究还表明，医生和 医疗系统治疗绝症患者。然而，现有的关于姑息治疗和末期护理质量的研究 主要集中在癌症患者身上，关于癌症患者的终末期护理质量的证据有限。 ADRD患者。事实上，很少有人知道医生和卫生系统的因素， 为ADRD患者提供姑息治疗和终末期护理的质量。这些知识差距阻碍了 努力制定干预措施，有效提高ADRD患者的终末期护理质量。 拟议的R 01将创建一个全面的多层次数据库，其中包括以下详细信息： 患者，医生和卫生系统，通过连接三个大型的，具有全国代表性的数据集：（1） Medicare索赔数据（患者因素），（2）Doximity医师数据库（医师因素），和（3）兰德 卫生系统数据库（卫生系统因素）。在目标1中，我们将利用这一创新数据库， 医生因素（例如，年龄、性别、临床经验、专科、住院医师和老年医学研究员培训 和/或姑息治疗），与EOL护理的质量（定义为（1）收到预付款 护理计划，姑息治疗和临终关怀，（2）EOL护理的积极性，（3）患者结局）， ADRD患者。在目标2中，我们将确定卫生系统因素（例如，学术医疗中心，利润 状态、规模、地区、ACO状态）。在目标3中， 重点关注在多个卫生系统执业的医生（约21%的医生在多个 卫生系统），我们将调查卫生系统因素是否影响医生的侵略性， 对ADRD患者的EOL护理。拟议的R 01将提供一个独特的机会，以推动该领域的发展， 更好地了解医生和卫生系统如何影响EOL护理质量的机制 提供给ADRD患者，特别关注可变的医生因素（例如，教育和培训 在老年医学和/或姑息治疗中）和卫生系统因素（例如，财政激励措施）， 终期护理质量。该项目将为制定干预措施提供强有力的证据基础（例如，CME， 针对ADRD患者的姑息治疗和EOL护理的医生，对ACO的经济激励）， 可有效提高终末期ADRD患者的护理质量。研究团队由 多个NIH资助的研究人员在所有相关领域的专业知识（使用大数据的卫生服务研究， 阿尔茨海默病和痴呆症研究、姑息治疗和终末期护理研究以及卫生系统研究）， 进行这项创新研究。拟议的研究与NIA的FOA非常一致，以解决临床和 转化研究的差距，以提高质量的终末期护理的人与ADRD及其家庭。