Home-Based Clinical Care for Persons with Dementia

痴呆症患者的家庭临床护理

• 批准号: 10265437
• 负责人: KATHERINE A ORNSTEIN
• 金额: $ 18.43万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10265437
• 关键词: Accounting; Address; Aging; Behavior; Caregivers; Caring; Characteristics; Clinical Services; Cognitive; Communities; Complex; Cost Savings; Data; Dementia; Evolution; Family; Family Caregiver; Fostering; Future; Gender; Geographic Locations; Growth; Health; Health Policy; Health Services Accessibility; Health and Retirement Study; Home; Home Care Services; Homebound Persons; Hospitalization; Individual; Institutionalization; Investigation; Knowledge; Link; Long-Term Care; Longitudinal cohort; Medical; Medicare; Medicare claim; Methods; Neighborhoods; Nurse Practitioners; Nurses; Outcome; Patient-Focused Outcomes; Patients; Persons; Physical Function; Physician Assistants; Physicians; Play; Population; Prevalence; Quality of Care; Research; Resources; Role; Safety; Self Care; Services; Social Work; Socioeconomic Factors; Travel; Unmarried; Vulnerable Populations; Work; adverse outcome; base; burden of illness; care coordination; care delivery; care preference; caregiving; clinical care; comorbidity; cost; density; experience; family caregiving; health care availability; health care service utilization; improved; improved outcome; individual variation; insight; institutional care facility; mental function; person centered; physical therapist; population based; rapid growth; social; social determinants; social factors; traditional care; trend; urban area

RP4 PROJECT SUMMARY Growth in the prevalence of dementia will intensify the challenges of delivering appropriate care to persons with dementia (PWD) and their family caregivers. Consistent with care preferences and evidence of cost savings, long-term care is shifting away from institutional care facilities to the home setting. PWD are increasingly living at home throughout the course of their illness, typically with multiple comorbid illnesses requiring concurrent management. The increasing delivery of home-based clinical care holds promise for supporting PWD and their family caregivers by allowing clinicians to address the complex social, environmental, medical, and safety concerns that emerge for this population. This project will critically enhance our understanding of the lives of persons with dementia by focusing on two key components of Medicare home-based clinical care delivery: (1) home-based medical care provided by physicians, physician assistants and nurse practitioners and (2) skilled home health care provided by professionals (e.g., nurses, physical therapists) on an episodic basis for homebound individuals. Using two longitudinal cohorts, the Health and Retirement Study (HRS) and the National Health and Aging Trends Study (NHATS), linked to Medicare claims and geospatial data, this project will document the utilization of home-based clinical services among PWD living in the community (Specific Aim 1), evaluate disparities in receipt of home-based clinical services (Specific Aim 2), and examine the consequences of these services (Specific Aim 3). Utilizing rich longitudinal cohorts, administrative data, geospatial analysis, and rigorous methods, this project examines disparities in home-based care delivery while considering key factors such as gender, function and coexisting illness burden. We will also evaluate the consequences of use of these services for patients and families. Such information will guide care delivery for this vulnerable population in the context of a growing shift towards person-centered, home-based care. Our results will inform the evolution of home-based medical care and skilled home health care policy. They will also instruct the larger context of home-based care delivery by offering insights on what fosters high quality care for persons with dementia. The proposed analyses can serve as a platform for future investigations examining best practices for serving PWD and their caregivers. Most importantly, the knowledge generated by this proposed study is an important step in developing and expanding services to support the growing numbers of PWD.

RP4项目摘要 痴呆症患病率的增长将加强向人提供适当护理的挑战 痴呆症（PWD）及其家庭护理人员。与护理偏好和成本证据一致 储蓄，长期护理正在从机构护理设施转移到家庭环境。 PWD是 在整个疾病过程中，越来越多地生活在家里，通常患有多种合并症 需要并发管理。基于家庭的临床护理的交付越来越有望 通过允许临床医生解决复杂的社会，支持PWD及其家庭护理人员 为该人群出现的环境，医疗和安全问题。这个项目将批判性增强 我们通过关注Medicare的两个关键组成部分来理解痴呆症患者的生活 基于家庭的临床护理分娩：（1）医师，医师助理提供的家庭医疗服务 和护士从业者以及（2）专业人士提供的熟练家庭保健（例如护士，身体 治疗师）以偶发性的为基础。使用两个纵向人群，健康和 退休研究（HRS）和国家健康与老化趋势研究（NHATS）与Medicare主张有关 和地理空间数据，该项目将记录PWD中基于家庭临床服务的利用 居住在社区（特定的目标1），评估收到家庭临床服务的差异 （特定目标2），并检查这些服务的后果（特定目的3）。利用丰富的纵向 该项目研究，行政数据，地理空间分析和严格的方法，该项目研究了差异 在考虑性别，功能和共存疾病等关键因素的同时，基于家庭的护理服务 负担。我们还将评估为患者和家庭使用这些服务的后果。这样的 信息将在越来越多的转变向朝向的情况下指导该脆弱人群的护理服务 以人为本的家庭护理。我们的结果将为家庭医疗服务的演变提供信息 熟练的家庭卫生保健政策。他们还将通过 提供有关为痴呆症患者提供高质量护理的见解。提出的分析可以服务 作为未来调查的平台，研究了为PWD及其护理人员服务的最佳实践。最多 重要的是，这项拟议的研究产生的知识是开发和扩展的重要步骤 支持越来越多的PWD的服务。