The impact of facility characteristics on racial disparities in ADRD mortality in nursing homes

项目摘要/摘要 这个有导师的Ruth L.Kirschstein国家研究服务奖将为学员，一名博士生提供 加州大学旧金山分校的流行病学，疗养院(NH)护理提供中社会不平等的必要培训， 阿尔茨海默病和阿尔茨海默病相关老年人死亡风险的决定因素 痴呆症(AD/ADRD)，以及在大型行政管理中分析和核算偏差的量化技能 数据集。在专家导师团队的指导下，学员将获得技能、实践经验和 学有所成，致力于学术研究事业的严谨应用 以流行病学方法研究正在进行的老龄化和保健服务的社会制度 社会不平等、健康不平等以及体制性和结构性种族主义。 新冠肺炎疫情加重了国民健康保险制度的负担，增加了设施特征的变化 包括人员配置比例和每个住院日的平均护士小时数。由此产生的系统性压力可能会突出 根据种族/民族，患有AD/ADRD的NH居民中长期存在的健康不平等的体制驱动因素。 虽然在新冠肺炎大流行期间出现了严重的种族不平等，但高死亡率的决定因素 这些不平等--尤其是在患有AD/ADRD的NH居民中--是未知的。以前的研究 国民健康保险制度中的超额死亡率没有探索像NH这样的时变的、与政策相关的变量的影响 入住率和人员配置特点。在学员以前工作的基础上，此F31使用链接的管理 数据集，包括加利福尼亚州的综合死亡率数据和来自 医疗保险和医疗补助服务中心：(目标1)估计大流行时代的总体超额死亡率和 在所有NH居民、患有AD/ADRD的NH居民和患有多发病的NH居民中按种族/民族分层 与AD/ADRD和(目标2)确定时不变和时变的设施/人员配置特征 这些人口中的超额死亡率和超额死亡率的种族差异。这项分析将提供政策- 将老年人置于危险之中并完成候选人培训的NH特征的相关证据旨在 让她参与正在进行的研究，以改善患有AD/ADRD的黑人和拉丁裔老年人的生活 国民健康保险制度。这项提议的主要优点是：(1)加州自2016年以来的州级死亡率普查； (2)同一时期加州所有NH设施的纵向普查数据；和(3)创新 关注高度脆弱老年人健康公平性研究差距的假设。获得的知识 这项研究将推进NIA的使命，即识别和评估产生 老年人在质量和获得护理方面的差距。在模范导师团队的指导下，建议的 培训将提高申请者的方法技能、研究能力和所需的内容专业知识 作为一名独立的学术研究人员，她专注于改善老年人的健康公平。

PROJECT SUMMARY/ABSTRACT This mentored Ruth L. Kirschstein National Research Service Award will provide the trainee, a PhD student in epidemiology at UCSF, necessary training in social inequalities in nursing home (NH) care delivery, determinants of mortality risk for older adults with Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD), and quantitative skills for analyzing and accounting for bias in large administrative datasets. Guided by a team of expert mentors, the trainee will gain the skills, practical experience, and knowledge to launch a successful academic research career dedicated to the application of rigorous epidemiologic methods to study the social systems of aging and health services in the context of ongoing social inequity, health inequality, and institutional and structural racism. The COVID-19 pandemic heightened the burden on NHs and increased variation in facility characteristics including staffing ratios and average nurse hours per resident day. The resulting systemic stress can highlight institutional drivers of long-standing health inequities among NH residents with AD/ADRD by race/ethnicity. While large racial inequalities in excess mortality occurred during the COVID-19 pandemic, the determinants of these inequalities—particularly among NH residents living with AD/ADRD—are not known. Prior studies of excess mortality in NHs have not explored the effects of time-varying, policy-relevant variables like NH occupancy and staffing characteristics. Building on prior work of the trainee, this F31 uses linked administrative datasets including comprehensive mortality data for the state of California and NH facility data from the Centers for Medicare and Medicaid Services to: (Aim 1) estimate pandemic-era excess mortality overall and stratified by race/ethnicity among all NH residents, NH residents with AD/ADRD, and multimorbid NH residents with AD/ADRD, and (Aim 2) identify time-invariant and time-varying facility/staffing characteristics linked to excess mortality and racial disparities in excess mortality in these populations. This analysis will deliver policy- relevant evidence on NH characteristics that put older adults at risk and fulfill the candidate’s training aims to position her for ongoing research to improve the lives of Black and Latinx older adults with AD/ADRD living in NHs. This proposal’s major strengths are: (1) a state-level census of mortality in California dating back to 2016; (2) longitudinal census data of all NH facilities in California over the same period; and (3) innovative hypotheses focusing on gaps in health equity research for highly vulnerable older adults. Knowledge gained from this research will advance the NIA’s mission to identify and evaluate structural factors that produce disparities in quality and access to care in old age. Guided by an exemplary mentorship team, the proposed training will enhance the applicant’s methodological skills, research competency, and content expertise needed for her career as an independent academic researcher focused on improving health equity for older adults.