The Influence of Primary Care Structural Capabilities on Hospitalizations among Older Adults with Dementia

目前，有580万美国人患有阿尔茨海默病和阿尔茨海默病相关痴呆 (AD/ADRD)。随着美国65岁及以上人口的持续增长，这一数字 患有AD/ADRD的美国人的比例也将增加，对住院等医疗服务的使用也将增加。 在患有AD/ADRD的老年人中，住院治疗比没有AD/ADRD的老年人更普遍 AD/ADRD。其中一些住院治疗被认为是潜在的可以避免的，如果个人有更好的 初级保健的可获得性和质量。然而，提供高质量的初级保健服务正变得越来越多 考虑到初级保健医生的预计短缺，这一挑战具有挑战性。另一方面，护士的数量 从业者(NP)近年来有所增长，到2025年将增加93%。此外，NPS提供了高度的 为老年人提供高质量、高成本效益的护理。然而，人们对如何支持NP的交付能力知之甚少 高质量的护理。特别是，人们对如何加强结构能力这一基本做法知之甚少 在NP为老年人提供护理的实践中，提供高质量护理所需的功能 AD/ADRD。通过加强保健等结构性能力加强初级保健的提供 初级保健中的协调、电子健康记录(EHR)和社区整合可以是 减少AD/ADRD老年患者住院率的有效途径。总的目标是 建议的研究是评估初级保健结构能力在使用非政府组织的实践中的影响 关于患有AD/ADRD的医疗保险受益人的全原因住院和潜在可避免的住院。这 论文研究将使用2018-2019年从一个大型国家研究所产生的独特的横断面数据 健康资助的研究及其相关的阿尔茨海默氏症补充剂(PI：Poghosyan，R01 MD011514-03S1)。 提出了以下具体目标：目标1.描述结构性能力(即提供护理的情况 协调、电子病历和社区整合)在初级保健实践中，非营利组织向联邦医疗保险提供护理 AD/ADRD受益人。目标2.评估结构能力对初级保健做法的影响 在医疗保险受益人中使用NPS进行潜在的可避免和全原因住院治疗 AD/ADRD。我们假设，更多的结构性能力将与较低的住院率相关 在患有AD/ADRD的医疗保险受益人中，与结构性能力较少的做法相比。多个- 将使用水平线性回归模型来评估结构能力对住院的影响 在患有AD/ADRD的老年人中。这项研究的发现将产生关于结构如何 能力可能改善患有AD/ADRD的老年人的初级保健提供。拟议的研究很好地- 与国家老龄研究所的使命保持一致，以确定减轻疾病负担的方法，如 AD/ADRD患者的住院情况。此外，这项R36研究将允许博士生研究生 培养成为一名独立的卫生服务研究员所需的技能。

Currently, 5.8 million Americans have Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD). As the segment of the United States population age 65 and older continues to grow, the number of Americans with AD/ADRD and the use of health care services such as hospitalizations will also increase. Hospitalizations are more prevalent among older adults with AD/ADRD compared to older adults without AD/ADRD. Some of these hospitalizations are considered potentially avoidable if individuals have better access to and quality of primary care. However, delivering high quality primary care is becoming increasingly challenging given the projected shortage of primary care physicians. On the other hand, the number of nurse practitioners (NPs) has grown in the recent years and will increase by 93% by 2025. Further, NPs deliver high- quality and cost-effective care to older adults. Yet, little is known about how to support NPs' ability to deliver high quality care. Particularly, little is known about how to strengthen structural capabilities, essential practice features needed for delivering high quality of care, in practices where NPs provide care to older adults with AD/ADRD. Enhancing primary care delivery through strengthening structural capabilities such as care coordination, the Electronic Health Record (EHR), and community integration in primary care can be an effective potential way to reduce hospitalizations among older adults with AD/ADRD. The overall objective of the proposed study is to assess the effects of primary care structural capabilities in practices employing NPs on both all-cause and potentially avoidable hospitalizations among Medicare beneficiaries with AD/ADRD. This dissertation study will use unique cross-sectional data produced in 2018-2019 from a large National Institutes of Health-funded study and its associated Alzheimer's supplement (PI: Poghosyan, R01 MD011514-03S1). The following specific aims are proposed: Aim 1. Describe structural capabilities (i.e., availability of care coordination, EHR, and community integration) in primary care practices where NPs provide care to Medicare beneficiaries with AD/ADRD. Aim 2. Assess the impact of structural capabilities in primary care practices employing NPs on potentially avoidable and all-cause hospitalizations among Medicare beneficiaries with AD/ADRD. We hypothesize that more structural capabilities will be associated with lower hospitalizations among Medicare beneficiaries with AD/ADRD compared to practices with fewer structural capabilities. Multi- level linear regression models will be used to assess the impact of structural capabilities on hospitalizations among older adults with AD/ADRD. Findings from this study will generate evidence about how structural capabilities may improve primary care delivery for older adults with AD/ADRD. The proposed study is well- aligned with the mission of the National Institute of Aging to identify ways to reduce illness burdens such as hospitalizations among those with AD/ADRD. In addition, this R36 study will allow a pre-doctoral student to develop the skills needed to become an independent health services researcher.