Person-Reported and Health Care Utilization Outcomes of Home and Community Based Care Recipients With and Without Alzheimer's Disease and its Related Dementias

项目摘要： 超过500万美国人患有阿尔茨海默病和相关痴呆症 (AD/ADRD），他们得到1600多万家庭护理人员的照顾。提供高 在社区为AD/ADRD患者提供高质量的护理是国家的优先事项。人 参加Medicaid的AD/ADRD有资格获得基于家庭和社区的 服务（HCBS）。HCBS计划因州而异，但一般包括支持性服务（例如， 成人日间服务和个人护理）。HCBS由各州提供，作为 机构护理，并被认为可以促进客户的独立性、健康、福祉和 有助于避免或延迟更密集的卫生保健利用（例如，疗养院入院）。但 关于HCBS对AD/ADRD患者的影响知之甚少，包括 有和没有AD/ADRD的人报告的结果不同，以及人- 报告的HCBS结果影响卫生保健的使用。确定HCBS是否改善 我们必须首先更好地了解这些服务的作用， 护理接受者的观点（即，个人报告的结果）。为此，我们建议 使用国家核心指标-老龄化和残疾（NCI-AD）成人消费者的数据 2017-2020年期间收集的调查（每年n> 17，000名HCBS受访者）， 从客户的角度看HCBS的质量和服务结果。我们还建议将NCI-AD 以及明尼苏达州受访者的医疗保险和医疗补助索赔（这是唯一一个 联系是目前可能的），以了解个人报告的HCBS之间的关系 结果和卫生保健使用。针对RFA AG-20-037，我们提出以下建议 具体目标：1.记录客户使用和/或期望的HCBS趋势， 没有AD/ADRD。我们预计AD/ADRD患者将表示更愿意使用 与没有AD/ADRD的人相比，他们目前接受的六氯代苯更多。2.确定 促进个人报告的HCBS结果的客户和国家层面的因素， 患有和不患有AD/ADRD的人。假设2a：AD/ADRD患者将有 与没有AD/ADRD的人相比，人报告的HCBS结果明显较差。 假设2b：相对于机构护理，国家对HCBS的投资将增加 对于有和没有的客户， AD/ADRD。3.确定健康计划级HCBS个人报告 质量和卫生保健使用（急诊室、住院、潜在 可避免的住院治疗和疗养院入院）， AD/ADRD。从高质量计划中获得HCBS的客户（基于个人报告 结果）将比他们的同行使用更少的医疗保健，这种差异将更大， AD/ADRD患者。这项研究有可能产生新的证据，无论是如何HCBS 影响AD/ADRD患者的重要结果，以及 保健用途。

Project Abstract: More than 5 million Americans live with Alzheimer's disease and related dementias (AD/ADRD), and they receive care from more than 16 million family caregivers. Providing high quality care in the community for people with AD/ADRD is a national priority. Persons with AD/ADRD who are enrolled in Medicaid are eligible to receive home and community-based services (HCBS). HCBS programs vary by state but in general include supportive services (e.g., adult day services and personal care). HCBS are provided by states as an alternative to institutional care and are believed to promote the clients’ independence, health, well-being and help avoid or delay more intensive health care utilization (e.g., nursing home admission). But very little is known about the impact of HCBS for people living with AD/ADRD, including whether person-reported outcomes differ for those with and without AD/ADRD, and whether person- reported HCBS outcomes influence use of health care. To determine whether HCBS improve outcomes that matter to clients, we must first better understand the role of these services from the perspective of care recipients (i.e., person-reported outcomes).Toward that end, we propose to use data from the National Core Indicators-Aging and Disabilities (NCI-AD) Adult Consumer Survey collected between 2017-2020 (n>17,000 HCBS respondents each year), which measure HCBS quality and service outcomes from clients’ perspectives. We also propose to link NCI-AD and Medicare and Medicaid claims for respondents in Minnesota (the only state where this linkage is currently possible) to understand the relationship between person-reported HCBS outcomes and health care use. In response to RFA AG-20-037 we propose the following specific aims: 1. Document trends in the HCBS used and/or desired by clients with and without AD/ADRD. We expect that persons with AD/ADRD will indicate a greater desire to use more HCBS than they currently receive compared to those without AD/ADRD. 2. Determine client and state-level factors that promote person-reported HCBS outcomes among persons with and without AD/ADRD. Hypothesis 2a: Persons with AD/ADRD will have significantly poorer person-reported HCBS outcomes than persons without AD/ADRD. Hypothesis 2b: Greater state investment in HCBS relative to institutional care will be associated with significantly more positive person-reported outcomes for clients both with and without AD/ADRD. 3. Determine the association between health plan-level HCBS person-reported quality and health care use (emergency department, hospitalizations, potentially avoidable hospitalizations, and nursing home admission) for persons with and without AD/ADRD. Clients who receive HCBS from high quality plans (based on person-reported outcomes) will use less health care than their counterparts, and this difference will be larger for clients with AD/ADRD. This study has the potential to yield new evidence both for how HCBS influence important outcomes for persons with AD/ADRD, and for the policy-relevant outcome of health care use.