Did Covid and the Transition to Telehealth Change Person-Reported Outcomes for Home and Community Based Care Recipients With and Without Alzheimer's Disease and its Related Dementias?

为数百万人提供高质量的家庭和社区服务（HCBS） 患有阿尔茨海默病和相关痴呆症（AD/ADRD）的美国人及其 护理人员是国家优先事项。HCBS，通常由医疗补助资助，作为护理的替代方案 家庭，是个人和家庭的首选。然而，2019冠状病毒病疫情 中断了HCBS，导致临时关闭并转向虚拟护理。疫情期间， HCBS提供商不得不调整他们的服务，暂时取消一些或永久取消 关门了国家允许向虚拟护理的转变，但AD/ADRD患者有复杂的 医疗条件，可能是具有挑战性的，以解决虚拟。这种破坏可能会导致 消费者，特别是AD/ADRD患者，需求未得到满足。为了了解 流行对HCBS使用，未满足的需求和个人报告的结果，我们的研究旨在 检查在大流行期间所使用的HCBS与所需的HCBS的变化，包括使用虚拟 在乎国家核心指标-老龄化和残疾（NCI-AD）成人消费者 将对调查进行分析，比较大流行前和大流行时期。NCI-AD措施 HCBS从消费者的角度得出结果，并包括有关体验的问题 在大流行期间。这项研究有三个具体目标： 目标1A：确定消费者使用和期望的六氯代苯的变化， 在COVID-19大流行之前和期间没有AD/ADRD。 目标1B：确定虚拟护理的使用是否会调节使用与 在大流行期间，对于患有和不患有AD/ADRD的人， 目标2A：确定HCBS个人报告的消费者结果的变化， 以及在COVID-19大流行之前和期间没有AD/ADRD。 目标2B：确定虚拟护理的使用是否会调节HCBS之间的差异 在大流行期间，患有和不患有AD/ADRD的消费者的结果。 目标3：检查HCBS虚拟护理实施的障碍和促进因素， 可能会影响个人报告的结果。 这项研究的影响是重大的，因为它符合国家的建议， 改善AD/ADRD的HCBS，并将告知虚拟护理作为交付模式的可行性 HCBS。这是至关重要的，因为人们对虚拟护理越来越感兴趣，以应对后医疗时代的挑战。 大流行时代和医疗保健系统中持续存在的人员配备问题。

Providing high-quality home and community-based services (HCBS) for the millions of Americans living with Alzheimer's disease and related dementias (AD/ADRD) and their caregivers is a national priority. HCBS, often funded by Medicaid as an alternative to nursing homes, are preferred by individuals and their families. However, the COVID-19 pandemic disrupted HCBS, leading to temporary closures and a shift to virtual care. During the pandemic, HCBS providers had to adapt their services, temporarily eliminating some or permanently closing. States allowed the shift to virtual care, but individuals with AD/ADRD have complex medical conditions that may be challenging to address virtually. This disruption likely left consumers, especially those with AD/ADRD, with unmet needs. To understand the effects of the pandemic on HCBS use, unmet needs, and person-reported outcomes, our study aims to examine changes in HCBS used vs desired during the pandemic, including the use of virtual care. Data from the National Core Indicators-Aging and Disabilities (NCI-AD) Adult Consumer Survey will be analyzed, comparing pre-pandemic and pandemic periods. NCI-AD measures HCBS outcomes from consumers' perspectives and includes questions about experiences during the pandemic. The study has three specific aims: Aim 1A: Determine the change in used and desired HCBS by consumers with and without AD/ADRD before and during the COVID-19 pandemic. Aim 1B: Identify whether the use of virtual care moderates the differences between used vs desired HCBS during the pandemic for people with and without AD/ADRD. Aim 2A: Determine the change in HCBS person-reported outcomes for consumers with and without AD/ADRD before and during the COVID-19 pandemic. Aim 2B: Identify whether the use of virtual care moderates the differences between HCBS outcomes during the pandemic for consumers with and without AD/ADRD. Aim 3: Examine barriers and facilitators to HCBS virtual care implementation that could impact person- reported outcomes. The impact of this research is significant as it aligns with national recommendations to improve HCBS for AD/ADRD and will inform the viability of virtual care as a model for delivering HCBS. This is crucial given the growing interest in virtual care to address challenges in the post- pandemic era and the ongoing staffing issues in the healthcare system.