Inequities in Home and Community-Based Services Access and Disparities in Alzheimer's Disease and Related Dementias

项目摘要--项目1 为阿尔茨海默病和相关痴呆症(ADRD)患者提供护理的公共资金历来有利于 长期护理机构的护理高于社区提供的护理。然而，大多数人都表达了这样的愿望 尽可能长时间地留在社区(而不是一个机构)。1999年美国最高法院 Olmstead决定，以及几项联邦和州倡议，以鼓励平衡医疗补助覆盖的长期 面向社区环境的服务和支持(LTS)，导致了家庭和通信的稳步扩展 基于身份的服务(HCBS)，包括支持养老院符合条件的个人的医疗和非医疗服务- 希望留在社区的肌萎缩侧索硬化症机构护理的质量较低，对长期护理服务的需求更大。 患有ADRD的黑人和西班牙裔成年人以及残疾人。然而，这种扩张并没有在 关于六氯联苯与可用替代品的比较以及它是否确实减少的大量证据 不平等。采用顺序说明性设计和当代医疗补助数据相结合的混合方法。 双重资格受益人的护理数据，项目1将完成三个目标：目标1.确定行政和 在有双重资格享受医疗保险的国家样本中，获得HCBS服务的自我报告预测因素 以及2010至2024年间基于索赔诊断的ADRD的医疗补助。目标2.评估差异的影响-- 关于疗养院使用、生活质量和功能、不良事件等方面差异的参考文献 以及基于索赔诊断的双重资格受益人的社会风险、临终关怀和死亡率 2010年至2024年期间的ADRD。目的3.探讨ADRD患者和护理伙伴的决策过程 评估HCBS使用和医疗补助管理员、HCBS机构和直接服务提供商对障碍的评估- 促进和促进者将促进发展援助方案的扩展，使之惠及ADRD受益人。通过探索州和联邦政策以及 关于促进或阻碍长期技术支持服务获取和成果公平的机制，我们将找出减少- 在成人ADRD患者中发现种族、民族和残疾方面的差异。除了与Core B合作之外 和本计划项目赠款(PPG)中的核心C，这项工作也将受益于项目3(估计)中得出的数据 目标1)为ADRD提供区域初级保健质量，与项目4合作，将急诊护理服务纳入具体情况- 进入目标2，并与项目2合作，为目标3招募关键线人。通过探索州和联邦 促进或阻碍可持续发展服务获取和成果公平的政策和机制，该项目将协同 通过更大的PPG来确定政策杠杆，以减少成年人之间的种族、民族和残疾差距 和ADRD在一起。

PROJECT SUMMARY – PROJECT 1 Public financing of care for patients with Alzheimer’s disease and related dementias (ADRD) has historically favored long-term nursing facility care over care provided in the community. Most individuals, however, express the desire to remain in the community (rather than an institution) for as long as possible. The 1999 U.S. Supreme Court Olmstead decision, and several Federal and state initiatives to encourage balancing of Medicaid-covered long-term services and supports (LTSS) toward community settings, have led to a steady expansion of home- and commu- nity-based services (HCBS), including medical and non-medical services to support nursing-home eligible individu- als wishing to remain in the community. The quality of institutional care is lower, and the need for LTSS is greater in Black and Hispanic adults with ADRD, and among people with disabilities. Yet the expansion has occurred without substantial evidence regarding how HCBS compares to available alternatives and whether it does, in fact, reduce inequities. Using a mixed methods sequential explanatory design and contemporary Medicaid data linked to Medi- care data for dual-eligible beneficiaries, Project 1 will complete three aims: Aim 1. To identify administrative and self-reported predictors of HCBS service receipt in a national sample of beneficiaries dually eligible for Medicare and Medicaid with claims-based diagnosis of ADRD between 2010 and 2024. Aim 2. To estimate the impact of dif- ferences in HCBS service receipt on disparities in nursing home use, quality of life and function, adverse events and social risks, end-of-life care, and mortality among dual-eligible beneficiaries with claims-based diagnosis of ADRD between 2010 and 2024. Aim 3. To explore ADRD patient and care partner decision-making processes re- garding HCBS use and Medicaid administrators, HCBS agency, and direct service providers’ assessments of barri- ers and facilitators to HCBS expansion for beneficiaries with ADRD. By exploring state and Federal policies and mechanisms that enhance or impede equity in LTSS access and outcomes, we will identify policy levers for reduc- ing disparities by race, ethnicity, and disability among adults with ADRD. In addition to collaborating with Core B and Core C in this Program Project Grant (PPG), this work will also benefit from data derived in Project 3 (estimates of regional primary care quality for ADRD for Aim 1), collaboration with Project 4 to contextualize acute-care out- comes in Aim 2, and partnership with Project 2 to recruit key informants for Aim 3. By exploring state and Federal policies and mechanisms that enhance or impede equity in LTSS access and outcomes, this project will synergize with the larger PPG to identify policy levers for reducing disparities by race, ethnicity, and disability among adults with ADRD.