Nursing Home Care Disparities for Hispanic Medicare Advantage and Fee-For-Service Beneficiaries with Alzheimers and Related Dimentias

项目总结 由于阿尔茨海默病和相关痴呆症(ADRD)在西班牙裔老年人中的发病率不断上升， 阿尔茨海默氏症协会强调了进行研究以了解更多这种疾病的重要性。 西班牙裔人口中的一大部分。拉美裔一直是诺姆中增长最快的少数群体之一- 在白人居民数量减少的情况下，为居民提供住房。然而，大多数关于ADRD的研究 对拉美裔美国人的关怀主要集中在家庭护理上，关于养老院护理的研究很少。所有的 关于ADRD患者的护理和预后的先前研究来自于参加传统治疗的患者。 传统医疗保险，在管理保健计划中对ADRD患者的研究非常少。即使是在 医疗保险优势(MA)计划在资助和提供老年少数族裔护理方面发挥着关键作用。 尤其是西班牙裔，因为大约40%的人注册了MA。这引发了一个关键的知识鸿沟-- 事业在过去的12年里，参加管理型医疗的受益人人数从5.3人增加了两倍多 从2004年的100万人增加到2016年的1760万人。对他们的临床表现负责的MA计划有 实施改善护理的战略，要么有选择地与高绩效提供商签约，要么通过 为那些有复杂保健需求的人直接启动护理管理战略。这可能是 为ADRD患者提供协调的、以患者为中心的、具有成本效益的护理。是否独一无二 管理保健计划的支付和组织结构转化为不同的使用和结果 对患有ADRD的少数民族患者的养老院护理是未知的。这次R03的目标是，下一步 议程是在全国医疗保险样本中评估拉美裔美国人在ADRD护理质量方面的差异 参加按服务收费计划和MA计划的人。我们的工作假设是，在ADRD患者中，他的- 患有ADRD的恐慌患者更有可能接受质量较低的长期护理提供者的护理，而且 管理式医疗将减少医疗质量方面的差异。我们的具体目标是：目标1.评估质量 为新入院的MA和医疗保险收费的西班牙裔ADRD患者提供的疗养院护理 与患有ADRD的非西班牙裔白人进行比较；以及目标2。描述疗养院内部和之间的 患有ADRD的西班牙裔居民短期和长期居住结果的差异。该项目将使用详细的 来自美国所有获得联邦医疗保险认证的疗养院的全面临床和功能评估数据。 我们的期望是，这个项目将提供对正规护士在医疗质量方面的差异的了解- 为ADRD患者提供居家护理。我们的结果可以为促进更高质量的医疗保险政策提供参考 通过了解管理式医疗计划在降低种族-民族差异方面的作用来关心拉美裔美国人。我们的 贡献是巨大的，因为联邦政策继续促进受益人参加MA计划- 为弱势群体的护理质量提供证据，例如患有ADRD的西班牙裔美国人。

PROJECT SUMMARY Due to the growing prevalence of Alzheimer’s disease and related dementias (ADRD) among elder Hispanics, the Alzheimer’s Association has emphasized the importance of conducting research to learn more of this con- dition in the Hispanic population. Hispanics have been one of the fastest-growing minority groups among nurs- ing home residents while the number of White residents is decreasing. However, most studies about ADRD care for Hispanics have focused on family caregiving, with very little research about nursing home care. All of the prior research on the care and outcomes of patients with ADRD is derived from patients enrolled in tradi- tional Medicare, with remarkably few studies of persons with ADRD in managed care plans. Even though the Medicare Advantage (MA) program plays a critical role in financing and delivering care for older minorities, es- pecially Hispanics since approximately 40% are enrolled in MA. This raises a critical gap in knowledge be- cause over the past 12 years, the number of beneficiaries enrolled in managed care more than tripled from 5.3 million in 2004 to 17.6 million in 2016. MA plans, which are accountable for their clinical performance, have implemented strategies to improve care, either by selectively contracting with high-performing providers or di- rectly initiating care management strategies for those with complex health care needs. This could be the key to the delivery coordinated, patient-centered, and cost-effective care for people with ADRD. Whether the unique payment and organizational structure of managed care plans translates into differential use and outcomes of nursing home care for minority people with ADRD is unknown. The objective of this R03, the next step in this agenda, is to assess disparities among Hispanics in the quality of ADRD care in a national sample of Medicare enrollees in fee-for-service and MA plans. Our working hypotheses are that, among persons with ADRD, His- panics with ADRD would be more likely to receive care from lower quality long-term care providers, and that managed care would reduce disparities in quality of care. Our specific aims are: Aim 1. To evaluate the quality of nursing home care that serve newly admitted MA and Medicare fee-for-service Hispanic patients with ADRD compared to non-Hispanic whites with ADRD; and Aim 2. To characterize within- and between- nursing home’s disparities in short- and long-stay resident’s outcomes for Hispanics with ADRD. This project will use detailed comprehensive clinical and functional assessment data from all Medicare-certified nursing homes in the US. Our expectation is that this project will provide understanding of disparities in health care quality of formal nurs- ing home care for those with ADRD. Our results can inform Medicare policies that promote better quality of care for Hispanics by understanding the role of managed care plans in lowering racial-ethnic variations. Our contribution is significant since federal policy continues to promote beneficiaries’ enrollment in MA plans with- out evidence about the quality of care for vulnerable populations, such as Hispanics with ADRD.