Do physicians who specialize in nursing home care provide higher quality care for nursing home residents with Alzheimer's Disease and related dementias?

项目总结/摘要 护理之家（NH）评估和管理（E&M）索赔比例高的医生数量 患者，通常被称为“SNFists”或“NH专家”，从2007年的1496人增长到2014年的2225人，占48.2%。 增加尽管这种增长，几乎没有什么是已知的医生专业化之间的关系，在NH 护理和护理质量提供给长期居住的NH居民。这对于那些有着 阿尔茨海默病及相关痴呆症（ADRD）。ADRD 亿 接收 是一种渐进的，无法治愈的疾病， 每年的医疗保健支出。大多数费用发生在疾病后期的个人身上 长期护理。ADRD诊断后的平均预期寿命为4至8年， 个体可以存活长达20年。75%的ADRD患者将在80岁时进入NHS，而 占总人口的4%在ADRD患者中，大约70%会死于NHs。既长 疾病的持续时间和对NH护理的依赖增加了改善护理质量的重要性 为长期居住在NH的ADRD居民提供。医生的参与对于提供长期护理至关重要。 高质量的ADRD在NHS的居民。在NHS内部，医生负责开发和监督 为居民提供全面的护理服务。NH护理中的医生专业化可以通过以下方式提高其有效性： 发展NH法规，药物指南和NH居民面临的常见行为综合征的知识 关于ADRD NH护理的专业化也可以帮助医生与患者建立长期的关系， 家庭/照顾者之间的关系，从而更好地认识到双方的需要。本研究的主要目的是确定 专门从事NH护理的医生为ADRD居民提供更高质量的护理。这将通过两个 索赔数据的定量分析和通过NH半结构化访谈收集的定性数据分析 领导我通过这个奖项接受的培训将为我提供临床护理的知识， ADRD患者以及定性研究方法的培训，补充了我已经掌握的定量技能， 拥有.我通过这次培训开发的丰富技能将使我能够将定性和定量的结果联系起来， 定量研究，产生急需的证据，为政策和临床指南提供信息，以优化 医生在护理提供给长期居住的NH居民与ADRD。

Project Summary/Abstract The number of physicians with a high proportion of evaluation and management (E&M) claims for nursing home (NH) patients, often referred to as “SNFists” or “NH specialists,” grew from 1496 in 2007 to 2225 by 2014, representing a 48.2% increase. Despite this increase, virtually nothing is known about the relationship between physician specialization in NH care and the quality of care provided to long-stay NH residents. This is particularly important for residents with Alzheimer's Disease and Related Dementias (ADRD). ADRD billion receiving is a progressive, incurable illness that accounts for $226 in health care spending annually. The majority of costs are incurred among individuals in later stages of the disease long-term care. The average life expectancy 4 to 8 yearsfollowing a diagnosis of ADRD is , although some individuals may survive up to 20 years. 75% of people with ADRD will be admitted to NHs by the age of 80 compared to 4% of the general population. Amongindividuals with ADRD, approximately 70% will die inNHs. Both the long duration of the disease and the reliance on NH care increases the importance of improvements in the quality of care provided to long-stay NH residents with ADRD. Physician involvement is essential to the delivery of long-term care of high quality to residents with ADRD in NHs. Within NHs, physicians are responsible for developing and overseeing comprehensive care planning for residents. Physician specialization in NH care may improve their effectiveness by developing knowledge of NH regulations, drug guidelines, and common behavioral syndromes faced by NH residents with ADRD. Specialization in NH care may also help physicians build long-term relationships with patients and families/caregivers leading to better recognition of the needs of both. The primary objective of this study is to determine if physicians who specialize in NH care provide higher quality care to residents with ADRD. This will be done through both quantitative analyses of claims data and analyses of qualitative data collected through semi-structured interviews of NH leadership. The training that I receive through this award will provided me with knowledge of the clinical care received by ADRD patients as well as training in qualitative research methods that complement the quantitative skills that I already possess. The rich skillset that I develop through this training will allow me to connect the results of qualitative and quantitative research that generates much-needed evidence to inform policies and clinical guidelines to optimize the role of physicians in the care provided to long-stay NH residents with ADRD.