Improving Acute Disease Management for Patients with Alzheimer's Disease and Related Dementias

项目概要-项目4 对于580万被诊断患有阿尔茨海默病和相关痴呆症（ADRD）的美国人来说，急性 肺栓塞（PE）和急性心肌梗死（AMI）等疾病提出了独特的挑战 用于诊断和治疗。ADRD患者承受着不成比例的急性疾病负担， 患病风险更高，检测和治疗率更低。在护理途径的每一步，测试和 ADRD患者的治疗决策因临床表现的差异而复杂， 沟通，以及对高强度护理的潜在恢复的不确定性。如果ADRD患者有 更难以沟通他们的病史和症状，或者如果他们出现不同的症状 和风险因素，临床医生可能更难辨别患者风险。关注患者康复 高强度护理、提供者偏见和患者不同的护理目标也可能导致低比率 测试和治疗。在这个项目中，我们将调查如何索赔为基础的诊断ADRD影响 诊断检测的速度和目标，以及更密集的检测和治疗的好处和风险。 目的1：研究PE和AMI的检测决策如何取决于诊断的ADRD的存在， 认知障碍的严重程度。目标2：开发并验证医院级PE和AMI检测措施 有和没有ADRD的患者的强度和诊断过程。目标3：使用工具变量， 测试在ADRD高危患者中对PE和AMI进行更密集检测的医院是否能够 更好或更差的健康结果。除了与核心B和C合作外，我们还将 与项目1，以了解如何获得家庭和社区为基础的服务影响疗养院的使用 从急性病中恢复过来。与项目3合作，我们将测试区域初级保健质量 预测PE或AMI后的护理利用和健康结局。在这项研究中，我们将研究如何或多或少 积极的测试和治疗策略与患者的结果相关，包括疗养院的使用， 死亡率、延迟诊断和不良健康事件。这些结果将为共同决策提供信息， 提供者，患者和护理人员，阐明了PE强化检测和治疗的临床权衡 还有AMI。

PROJECT SUMMARY – PROJECT 4 For the 5.8 million Americans diagnosed with Alzheimer’s disease and related dementia (ADRD), acute illnesses such as pulmonary embolism (PE) and acute myocardial infarction (AMI) present unique challenges for both diagnosis and treatment. Patients with ADRD bear a disproportionate burden of acute disease, with higher disease risk and lower rates of testing and treatment. At each step of the care pathway, testing and treatment decisions for patients with ADRD are complicated by differences in clinical presentation, communication, and uncertainty about potential recovery from high-intensity care. If patients with ADRD have more difficulty communicating their history and symptoms, or if they present with different sets of symptoms and risk factors, clinicians may have greater difficulty discerning patient risk. Concern about patient recovery from high-intensity care, provider biases, and patients’ differing goals of care may also contribute to low rates of testing and treatment. In this project we will investigate how a claims-based diagnosis of ADRD affects the rate and targeting of diagnostic tests, as well as the benefits and risks of more intensive testing and treatment. Aim 1: Investigate how testing decisions for PE and AMI depend on the presence of diagnosed ADRD and severity of cognitive impairment. Aim 2: Develop and validate a hospital-level measure of PE and AMI testing intensity and diagnostic processes for patients with and without ADRD. Aim 3: Using instrumental variables, test whether hospitals with more intensive testing for PE and AMI among high-risk patients with ADRD achieve better or worse health outcomes for these patients. In addition to collaborating with Core B and C, we will work with Project 1 to contextualize how access to home and community-based services affect nursing home use and recovery from acute illness. In partnership with Project 3, we will test how regional primary care quality predicts care utilization and health outcomes after PE or AMI. In this study, we will examine how more or less aggressive testing and treatment strategies are associated with patient outcomes, including nursing home use, mortality, delayed diagnosis and adverse health events. These results will inform shared decision-making by providers, patients and caregivers, illuminating the clinical tradeoffs of intensive testing and treatment for PE and AMI.