Assessing Diagnosis and Treatment Delays and Health Care Disparities by Race/Ethnicity among Individuals with Alzheimer's Disease and Related Dementias

项目摘要/摘要 阿尔茨海默病和相关痴呆症(ADRD)的早期发现和处理对 改善患者结局，最大限度提高患者和照顾者的生活质量，并优化健康 护理利用情况。有证据表明，非洲裔美国人和西班牙裔美国人可能会经历ADRD诊断 尽管疾病患病率高于白人，但治疗仍有延误。更好地针对ADRD护理 跨种族和族裔群体的改善努力取决于对诊断和 这些人群中的治疗延迟、由此产生的健康结果和护理利用模式。 此应用程序调查ADRD诊断和管理中的种族和民族差异，来自 疾病的早期到临终阶段。我们将通过独特的认知测量来利用调查数据 健康和退休调查(HRS)以及老龄化、人口统计学和记忆力研究的作用 (ADAMS)，与联邦医疗保险和医疗补助索赔文件链接。HRS是一项持续的、全国性的美国调查。 50岁以上的成年人是社区居住和养老院居民的代表。HRS的面谈 每两年约有2万名受访者，非洲裔美国人和西班牙裔美国人的样本过多。使用这个 数据库，该数据库将索赔数据与基于人群的调查联系起来，该调查具有独特的认知功能衡量标准，以 评估ADRD的严重性，我们的研究可以解决先前研究的局限性，以实现以下目标： 目标1：根据疾病严重程度调整种族/民族来表征ADRD诊断延迟 假设1.1：患有早期ADRD的非洲裔美国人和西班牙裔美国人比白人更不可能收到 在他们的Medicare或Medicaid报销单上对ADRD进行编码诊断 假设1.2：非洲裔美国人和西班牙裔美国人在诊断ADRD时比白人更晚期 目标2：根据种族/民族对疾病进行调整，确定ADRD治疗延迟和停止的特征 严重性 假设2.1：非裔美国人和西班牙裔美国人比白人更不可能接受抗痴呆症治疗 初步诊断后的药物治疗 假设2.2：非洲裔美国人和西班牙裔美国人比白人更有可能停止抗痴呆症 初诊后的药物治疗 目标3：说明ADRD保健费用和临终关怀方面的种族和族裔差异， 根据疾病严重程度进行调整 假设3.1：患有ADRD的非洲裔美国人和西班牙裔美国人有更多潜在的可以避免的住院治疗， 比白人更多的计划外30天重新入院，以及更高的医疗费用 假设3.2：患有ADRD的非裔美国人和西班牙裔人临终关怀使用率较低，负担更大 临终干预，临终费用高于白人 1

Project Summary/Abstract Early detection and management of Alzheimer's Disease and Related Dementias (ADRD) is crucial to promoting patient outcomes, maximizing quality of life for both the patient and caregiver, and optimizing health care utilization. Evidence suggests that African Americans and Hispanics may experience ADRD diagnosis and treatment delays despite having a higher disease prevalence than whites. Better targeting of ADRD care improvement efforts across racial and ethnic groups depends on robust assessment of diagnosis and treatment delays, resulting health outcomes, and care utilization patterns in these populations. This application investigates racial and ethnic disparities in ADRD diagnosis and management, from the early to end-of-life stages of the disease. We will leverage survey data with unique measures of cognitive function from the Health and Retirement Survey (HRS) and the Aging, Demographics and Memory Study (ADAMS), linked with Medicare and Medicaid claims files. The HRS is a continuous, national survey of U.S. adults over age 50 representative of community-dwelling and nursing home residents. The HRS interviews ~20,000 respondents every two years, with oversampling of African Americans and Hispanics. Using this database, which links claims data to a population-based survey with unique cognitive functioning measures to assess ADRD severity, our study can address limitations of prior research to achieve the following aims: Aim 1: Characterize ADRD diagnosis delay by race/ethnicity, adjusting for disease severity Hypothesis 1.1: African Americans and Hispanics with early ADRD are less likely than whites to receive a coded diagnosis of ADRD on their Medicare or Medicaid claims Hypothesis 1.2: African Americans and Hispanics have more advanced ADRD at diagnosis than whites Aim 2: Characterize ADRD treatment delay and discontinuation by race/ethnicity, adjusting for disease severity Hypothesis 2.1: African Americans and Hispanics are less likely than whites to be treated with anti-dementia medications following initial diagnosis Hypothesis 2.2: African Americans and Hispanics are more likely than whites to discontinue anti-dementia medication therapy following initial diagnosis Aim 3: Characterize racial and ethnic disparities in ADRD health care costs and end-of-life care, adjusting for disease severity Hypothesis 3.1: African Americans and Hispanics with ADRD have more potentially avoidable hospitalizations, more unplanned 30-day readmissions, and higher health care costs than whites Hypothesis 3.2: African-Americans and Hispanics with ADRD have lower hospice use, more burdensome interventions at the end of life, and higher end-of-life costs than whites 1