Surgeon and hospital factors associated with racial and ethnic disparities in surgical outcomes among persons with AD/ADRD

摘要 这一拟议的补充审查种族和民族（R/E）的差异，手术结果和潜在的 阿尔茨海默病患者的影响因素，如外科医生和医院特征 及其相关痴呆（AD/ADRD）患者接受手术。 由于人口老龄化，患有AD/ADRD的人接受治疗变得越来越普遍。 一种外科手术，髋部骨折是最常见的适应症。现有研究表明， 接受手术的R/E少数群体患者的死亡率、并发症和 比白色患者的再入院率高。同样，AD/ADRD护理中的R/E差异，包括药物的使用， 和长期服务，存活率和死亡率，都有很好的记录。然而，对R/E知之甚少。 接受手术的AD/ADRD患者之间的手术结果差异。 为了解决这一知识缺口，我们将利用NIMHD母项目， 使用综合数据集，分析与手术结局中R/E差异相关的特征， 医疗保险索赔数据，Doximity医生数据库，美国医学院协会 医学院数据库和美国医学协会住院医师数据库。 在目标1中，我们将确定手术结果中的R/E差异（例如，停留时间， 并发症、30天、90天和1年手术死亡率）在AD/ADRD手术患者之间存在差异 与没有AD/ADRD的人相比。我们假设手术结果中的R/E差异是 AD/ADRD患者的病情恶化，因为他们的脆弱性和挑战， 与临床医生有效沟通，这是造成差异的重要因素。 在目标2中，我们将确定与手术结局中R/E差异相关的外科医生特征， AD/ADRD患者。我们假设外科医生的某些特征（例如，年龄、性别、R/E 医学院和住院医师项目的多样性，治疗的R/E少数患者数量）与 AD/ADRD患者的手术结果存在较大或较小的差异。 在目标3中，我们将确定与手术结果中R/E差异相关的医院特征， AD/ADRD患者。我们假设某些医院特征（例如，教学状况， 负责任的护理组织参与，董事会成员的多样性）与以下方面的差异有关： AD/ADRD患者的手术结局。我们还将与美国医院协会 医院数据库，美国医院协会国家卫生保健管理调查数据， AHRQ美国卫生系统概要，以获得医院特征。 该项目将确定与AD/ADRD患者差异相关的潜在可改变因素， 接受手术，并为未来的干预措施提供信息，以减少这一弱势群体的差距。

Abstract This proposed supplement examines the racial and ethnic (R/E) disparities in surgical outcomes and potential contributing factors—such as surgeon and hospital characteristics—among persons with Alzheimer’s disease and its related dementias (AD/ADRD) who undergo surgery. Due to the aging of the population, it has become increasingly common for persons with AD/ADRD to undergo a surgical procedure, with hip fracture being the most frequent indication. Existing studies have shown that patients from R/E minoritized communities undergoing surgery experience higher mortality, complications, and readmissions than White patients. Similarly, R/E disparities in AD/ADRD care, including the use of medications and long-term services, caregiving, and mortality, are well documented. However, little is known regarding R/E disparities in surgical outcomes among persons with AD/ADRD undergoing surgery. To address this knowledge gap, we will leverage the parent NIMHD project that examines surgeon characteristics associated with R/E disparities in surgical outcomes using a comprehensive dataset consisting of Medicare claims data, the Doximity physician database, the Association of American Medical Colleges Medical School database, and the American Medical Association Residency database. In Aim 1, we will determine whether the R/E disparities in surgical outcomes (e.g., length of stay, complications, 30-day, 90-day, and 1-year operative mortality) differ between surgical patients with AD/ADRD compared to those without AD/ADRD. We hypothesize that R/E disparities in surgical outcomes are exacerbated among persons with AD/ADRD because of their vulnerabilities and challenges with communicating with clinicians effectively, which is an important contributor to disparities. In Aim 2, we will identify surgeon characteristics associated with R/E disparities in surgical outcomes among persons with AD/ADRD. We hypothesize that certain characteristics of surgeons (e.g., age, gender, R/E diversity of medical school and residency program, number of R/E minoritized patients treating) are associated with larger or smaller disparities in surgical outcomes among persons with AD/ADRD. In Aim 3, we will identify hospital characteristics associated with R/E disparities in surgical outcomes among persons with AD/ADRD. We hypothesize that certain hospital characteristics (e.g., teaching status, accountable care organization participation, diversity of board members) are associated with disparities in surgical outcomes among persons with AD/ADRD. We will additionally link the American Hospital Association Hospital database, the American Hospital Association National Health Care Governance Survey data, and the AHRQ Compendium of US Health Systems to obtain hospital characteristics. This project will identify potentially modifiable factors associated with disparities in persons with AD/ADRD who undergo surgery and inform future interventions to reduce disparities in this vulnerable population.