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

• 批准号: 10619710
• 负责人: Lusine Poghosyan
• 金额: --
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 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 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10619710
• 关键词: Accident and Emergency department; Administrator; Alzheimer' s disease related dementia; American; Care given by nurses; Caring; Clinical; Communities; Continuity of Patient Care; Data; Dementia; Elderly; Emergency department visit; Ensure; Environment; Face; Future; Hospitalization; Individual; Intervention; Interview; Investments; Mediating; Medicare; Methods; Minority; Minority Groups; Nurse Practitioners; Outcome; Patients; Persons; Policies; Primary Care Physician; Primary Health Care; Research Priority; Resources; Socioeconomic Factors; Survey Methodology; Surveys; System; Telephone; acute care; beneficiary; community barrier; community intervention; cost; dementia care; design; deviant; ethnic health disparity; ethnic minority; health disparity; hospitalization rates; innovation; minority communities; multilevel analysis; racial and ethnic; racial and ethnic disparities; racial minority; response; underserved area

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)； 预计到2030年，这一数字将翻一番，到2050年将翻两番。种族和少数民族不成比例的现象受到影响。 少数群体痴呆症患者，特别是社区居民，缺乏高质量的持续初级教育 而且结果很差，如高住院率和急诊科使用率。 政策制定者警告说，随着我们面临初级保健医生短缺，健康差距将会扩大。护士 从业者(NPs)是增长最快的初级保健劳动力，可以缓解这些挑战。NPS 不成比例向少数群体提供照顾，并在许多少数群体居住的服务不足的地区开展活动。还没有 关于如何优化使用NPs的初级保健实践，人们知之甚少，因为NPs往往缺乏组织 以及确保少数群体残疾人的护理连续性和更好的结果所需的结构性属性。小才是 也知道如何增加社区资源，以消除残疾人士的健康差距。我们的混合- 方法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 急诊科就诊中种族和民族差异的实践属性(即关怀环境和结构能力) 以及残疾患者的住院情况，以及护理的连续性在多大程度上影响了这一效果。目标2. 评估社区社会经济因素和初级保健可获得性对急诊就诊差异的影响 以及残障人士的住院情况。目标3.确定实践和社区障碍以及关怀的促进者 高绩效和低绩效NP实践中的PWD。我们将使用社区居住的医疗保险受益人的数据 2017-2018年由NPS照顾的残疾儿童，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。所有关于病人，NPs，实践的数据， 社区将在多层次模型中进行合并和分析。我们还将确定低成本的做法 住院率和急诊就诊率(即高绩效做法)和高住院率和 对残疾人士进行教育访问(即表现欠佳的做法)，并使用 积极的偏离方法。我们将通过个人电话或在线采访约40名来自高级- 执行和约20个来自低绩效实践的NPs。采访将被录音和转录。数据将 进行内容分析。将对定量和定性调查结果进行三角划分，以告知管理员和 政策制定者寻求通过以下途径减少残疾人在急性护理使用方面的种族和民族差异 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 可以在表现不佳的做法中引入这一点，以加强对残疾患者、做法和社区的护理 最能从这种干预和未来投资中受益的国家。这项创新的研究有可能 通过促进数百万少数族裔社区的持续初级保健，做出临床和政策贡献- 住宅PWD，并响应高优先级研究主题NOT-AG-18-056和NOT-MD-19-016。