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Patient, Caregiver, and Regional Drivers of Potentially Inappropriate Medical Care for Dementia: Building the Foundation for State Dementia Policy

痴呆症医疗护理可能不适当的患者、护理人员和地区驱动因素：为国家痴呆症政策奠定基础

基本信息

批准号：
10090545
负责人：
DONOVAN T MAUST
金额：
$ 40.95万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-01 至 2023-07-31
项目状态：
已结题

项目摘要

4.7 million people in the United States had Alzheimer's disease in 2010, a number that is projected to nearly triple by 2050. While the National Plan to Address Alzheimer's Disease and Related Dementias is an effort to coordinate federal, state, and local efforts to confront this growing challenge, it explicitly states “this is a national plan and not a federal plan”, with individual states left to determine how to best care for these patients and their caregivers. Because of cognitive and functional changes as age-related dementia progresses, the needs of these patients and their caregivers extend far beyond healthcare, requiring a diverse response from states. However, the care most accessible to community-dwelling patients with age-related dementia is direct medical care. In addition, as a patient's ability to direct their own care declines, the healthcare provided to them may be driven by the needs and preferences of the caregiver. These patients then experience: fragmented medical care, poorly-coordinated across multiple outpatient providers; potentially preventable hospitalization; and overuse of antipsychotics despite extensive evidence of harms. Because of the state-led nature of the National Plan, it is critical to provide states with key predictors of this inappropriate care to help guide their policy. We will use national Medicare data, a national survey of older adults with dementia and their caregivers, and an Expert Panel of researchers and state policy experts to complete the following aims: (1) Identify patient and community factors associated with potentially inappropriate care delivered to community- dwelling adults with age-related dementia and establish accurate national and state-level estimates of this care. We will use a cross-sectional Medicare 20% sample to determine use of the following for all 50 states: a) potentially-preventable hospitalization; b) fragmented outpatient care; and c) antipsychotic use. (2) Determine the contribution of additional patient clinical, functional, caregiver, and caregiving characteristics to potentially inappropriate care relative to the effect of location. We will use the National Health and Aging Trends Study, National Survey of Caregivers, and Area Health Resource File to determine the patient, caregiver, and regional healthcare system characteristics associated with potentially inappropriate medical care for persons with dementia. (3) Develop an evidence-based policy making guide for dementia that we will use to interview state aging policy officials. An Expert Panel of dementia researchers and state aging policy experts will apply our Aim 1 and Aim 2 findings to develop an evidence-based policymaking framework with particular emphasis on populations most at risk, which we will use to guide interviews with state aging policy officials. The impact of our work will be to: 1) identify the patient, caregiver, and regional factors that contribute to potentially inappropriate medical care for patients with age-related dementia; 2) provide a baseline against which to measure future system-level interventions; and 3) develop a framework for states to develop evidence-based dementia care state plans.

4.7 2010年，美国有1000万人患有阿尔茨海默病，预计这一数字将接近1000万。到2050年翻三倍虽然解决阿尔茨海默病和相关痴呆症的国家计划是一项努力，协调联邦，州和地方的努力，以应对这一日益增长的挑战，它明确指出“这是一个国家计划，而不是联邦计划”，各州自行决定如何最好地照顾这些病人和他们的照顾者。由于随着年龄相关性痴呆的进展，认知和功能发生变化，这些患者及其护理人员的需求远远超出了医疗保健的范围，需要从 states.然而，社区老年痴呆患者最容易获得的护理是直接的，医疗等此外，随着患者指导自己护理的能力下降，提供给他们的医疗保健可以由护理者的需要和偏好驱动。这些患者随后经历：多个门诊提供者之间协调不良的医疗护理;可能可预防的住院治疗; 以及滥用抗精神病药物，尽管有大量证据表明其危害。由于国家主导的性质，国家计划，至关重要的是为各州提供这种不适当护理的关键预测因素，以帮助指导他们的政策我们将使用国家医疗保险数据，一项对老年痴呆症患者及其护理人员的全国性调查，以及由研究人员和国家政策专家组成的专家小组，以完成以下目标：（1）确定与向社区提供的潜在不适当护理相关的患者和社区因素- 居住的成年人与年龄相关的痴呆症，并建立准确的国家和国家一级的估计，这种关怀。我们将使用20%的横断面医疗保险样本，以确定所有50个陈述：a）潜在可预防的住院治疗; B）分散的门诊治疗;以及c）抗精神病药物的使用。（二）确定额外患者临床、功能、护理人员和护理人员的贡献特征到相对于位置的影响的潜在不适当护理。我们将利用国家健康和老龄化趋势研究，全国护理人员调查和地区健康资源文件，以确定患者、护理人员和区域医疗保健系统特征与潜在不适当的为痴呆症患者提供医疗服务。(3)为痴呆症制定循证决策指南我们将用它来采访州老龄化政策官员。一个由痴呆症研究人员组成的专家小组，州老龄化政策专家将应用我们的目标1和目标2的研究结果来制定基于证据的政策制定框架，特别强调风险最大的人群，我们将使用它来指导采访，国家老龄政策官员。我们工作的影响将是：1）确定患者，护理人员和区域导致对年龄相关性痴呆患者进行潜在不适当医疗护理的因素; 2）提供一个基线，用以衡量今后的系统一级干预措施; 3）制定一个框架，各州制定基于证据的痴呆症护理州计划。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Nursing Home Characteristics Associated with High and Low Levels of Antipsychotic, Benzodiazepine, and Opioid Prescribing to Residents with Alzheimer's Disease and Related Dementias: A Cross-Sectional Analysis.

DOI：
10.1016/j.jamda.2022.05.025
发表时间：
2022-11
期刊：
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
影响因子：
7.6
作者：
Candon, Molly;Strominger, Julie;Gotlieb, Evelyn;Maust, Donovan T.
通讯作者：
Maust, Donovan T.

Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014-2016.

DOI：
10.1111/jgs.17085
发表时间：
2021-06
期刊：
Journal of the American Geriatrics Society
影响因子：
6.3
作者：
Gerlach LB;Kales HC;Kim HM;Zhang L;Strominger J;Covinsky K;Teno J;Bynum JPW;Maust DT
通讯作者：
Maust DT

Reply to: Comment on: Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications.

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