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Care for Persons With Dementia in Nurse Practitioner Practices and Racial and Ethnic Health Disparities

护士执业实践中对痴呆症患者的护理以及种族和民族健康差异

基本信息

批准号：
10054712
负责人：
Lusine Poghosyan
金额：
$ 63.14万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
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/10054712
关键词：
Accident and Emergency department Address Administrator Affect Alzheimer&apos s disease related dementia American Area Care given by nurses Caring Chronic Disease Clinical Cognitive Communities Community Healthcare Competence Continuity of Patient Care Data Data Analyses Dementia Disease Disease Management Elderly Emergency department visit Ensure Environment Ethnic group Face Failure Family Future Geographic Information Systems Hispanics Hospitalization Individual Intervention Interview Investments Link Measures Mediating Mediation Medicare Methods Minority Modeling Nurse Practitioners Outcome Patient Care Patient-Focused Outcomes Patients Persons Policies Population Prevalence Primary Care Physician Primary Health Care Provider Qualitative Methods Quality of Care Race Reminder Systems Research Priority Resources Risk Factors Role Socioeconomic Factors Structure Survey Methodology Surveys System Telephone Time Training Visit acute care beneficiary care delivery care systems community intervention cost dementia care design deviant disparity reduction ethnic health disparity ethnic minority population follow-up health care settings health disparity hospitalization rates improved innovation minority communities multilevel analysis organizational structure primary outcome public health intervention racial and ethnic racial and ethnic disparities racial minority response therapy design

项目摘要

More than 5.7 million Americans are living with Alzheimer's disease and related dementias (AD/ADRD); this number is expected to double by 2030 and triple by 2050. Racial and ethnic minorities disproportionality suffer. Minority Persons With Dementia (PWD), particularly community-dwelling, lack high quality continuous primary care and have poor outcomes such as high rates of hospitalizations and emergency department (ED) use. Policymakers caution that health disparities will widen as we face a shortage of primary care physicians. Nurse practitioners (NPs), the fastest growing primary care workforce, could mitigate these challenges. NPs disproportionality deliver care to minorities and practice in underserved areas where many minorities live. Yet little is known about how to optimize primary care practices employing NPs, which often lack the organizational and structural attributes needed to ensure continuity of care and better outcomes for minority PWD. Little is also known about how to enhance community resources to eliminate health disparities for PWD. Our mixed- method national study will fill this gap. We will achieve three specific aims: Aim 1. Assess the effect of NP practice attributes (i.e., care environment and structural capabilities) on racial and ethnic disparities in ED visits and hospitalizations among PWD and the extent to which the effect is mediated by continuity of care. Aim 2. Assess the effect of community socioeconomic factors and primary care availability on disparities in ED visits and hospitalizations among PWD. Aim 3. Identify practice and community barriers and facilitators of caring for PWD in high- and low-performing NP practices. We will use data on community-dwelling Medicare beneficiary PWD cared for by NPs in 2017-2018 and will collect survey data from NPs (n= 4,414) about care environments and structural capabilities using both mail and online survey methods. All data about patients, NPs, practices, and communities will be merged and analyzed in multilevel models. We will also identify practices with low rates of hospitalizations and ED visits (i.e., high-performing practices) and high rates for hospitalizations and ED visits (i.e., low-performing practices) among PWD and collect qualitative interview data from NPs using a positive deviance approach. We will conduct individual telephone or online interviews with ~40 NPs from high- performing and ~20 NPs from low-performing practices. Interviews will be recorded and transcribed. Data will undergo content analysis. Quantitative and qualitative findings will be triangulated to inform administrators and policymakers seeking ways to reduce racial and ethnic disparities in acute care use among PWD through practice, policy, and community interventions. We will identify modifiable factors of high-performing practices that could be introduced in low-performing practices to enhance care to PWD and practices and communities that can most benefit from such interventions and future investments. This innovative study has the potential to make clinical and policy contributions by promoting continuous primary care to millions of minority community- dwelling PWD and is in response to High-Priority Research Topic NOT-AG-18-056 and NOT-MD-19-016.

超过570万美国人患有阿尔茨海默病和相关痴呆症（AD/ADRD）;这预计到2030年将增加一倍，到2050年将增加两倍。种族和少数民族的仇恨受到影响。少数群体痴呆症患者，特别是社区居民，缺乏高质量的连续性小学教育。护理和有不良的结果，如住院率和急诊科（艾德）的使用率高。政策制定者警告说，由于我们面临初级保健医生短缺的问题，健康差距将扩大。护士作为增长最快的初级保健劳动力，执业者（NP）可以缓解这些挑战。NPS 非营利组织为少数民族提供护理，并在许多少数民族居住的服务不足的地区开展工作。然而关于如何优化采用NP的初级保健实践知之甚少，这些实践往往缺乏组织能力，确保少数群体残疾人护理的连续性和更好的结果所需的结构属性。之甚少还了解如何增加社区资源，以消除残疾人的健康差距。我们的混合- 国家研究将填补这一空白。我们将实现三个具体目标：目标1。评估NP的效果实践属性（即，护理环境和结构能力）对艾德就诊中种族和民族差异的影响残疾人的住院率以及护理连续性对影响的影响程度。目标二。评估社区社会经济因素和初级保健可用性对艾德就诊差异的影响残疾人的住院率。目标3.确定护理的实践和社区障碍以及促进因素高性能和低性能NP实践中的PWD。我们将使用社区居住医疗保险受益人的数据 2017-2018年由NPs照顾的残疾人，并将从NPs（n= 4，414）收集有关护理环境的调查数据以及使用邮件和在线调查方法的结构能力。关于患者、NP、实践的所有数据，和社区将被合并并在多层次模型中进行分析。我们还将确定低风险的做法，住院率和艾德就诊率（即，高绩效做法）和高住院率，艾德访视（即，低绩效的做法），并收集定性访谈数据，从非营利组织使用积极的偏离方法我们将对约40名来自高- 从低绩效的做法和约20个NP。访谈将被记录和转录。数据将进行内容分析。将对定量和定性结果进行三角分析，以告知管理人员，政策制定者寻求减少残疾人在急性护理使用方面的种族和民族差异的方法，实践、政策和社区干预。我们将确定高绩效实践的可修改因素可以在低绩效实践中引入，以加强对残疾人的护理，以及实践和社区最能从这些干预措施和未来投资中受益的国家。这项创新研究有可能通过促进对数百万少数民族社区的持续初级保健，作出临床和政策贡献; 住宅PWD，并响应高优先级研究主题NOT-AG-18-056和NOT-MD-19-016。