Impact of AD/ADRD on Health-Related Outcomes in a Statewide Population Enrolled in a Publicly-Funded HCBS Waiver Program for Older Adults

项目摘要 许多州正在积极改革其长期服务和支持系统，通过限制 疗养院的增长和家庭和社区服务(HCBS)的扩大 医疗补助豁免计划，旨在最大限度地提高养老院风险个人的独立生活 关心。医疗补助HCBS豁免计划的资格标准包括经济和健康相关因素，后者 通常包括功能和认知缺陷。老年人口的医疗补助HCBS豁免计划 全州的成年人包括患有和不患有阿尔茨海默病的在家生活的人，以及 相关痴呆症(ADRD)以及广泛的认知缺陷，即使没有ADRD的诊断也是如此。 在基于人群的研究中，ADRD与许多与健康相关的不良后果有关 社区居住的老年人；然而，ADRD和认知障碍的严重程度是否以及如何 与接受医疗补助HCBS豁免计划服务的老年人的不良后果有关 是未知的。关于非正式照顾者支持系统的强度及其对不良反应的影响，我们知之甚少 在HCBS计划中，患有和不患有痴呆症的老年人的结果。成功实现自我确定的目标 老年医疗补助HCBS豁免参与者的护理状况，以及实现这些目标的障碍，也没有 在开展ADRD的背景下进行了探讨。此外，种族和族裔可能如何改变对 在这一人群中，ADRD、非正式支持系统和健康结果之间的关联尚不清楚。 我们建议在以人为本的指导下解决这些重要的和相互关联的知识差距 和健康差距概念框架。我们将研究康涅狄格州的全州人口 老年人居家护理计划(CHCPE)，老年人医疗补助HCBS豁免计划。CHCPE有一个 种族和民族多元化的人口，以及州医疗补助政策决策者表达了强烈的 对改善CHCPE参与者痴呆症护理的兴趣。在康涅狄格州，以人为中心的护理方法 规划和实施指导所有医疗补助HCBS豁免计划的政策和实践。 指导这项研究的具体目标是，在CHCPE参与者群体中： 目标1：确定携带ADRD的生活与卫生服务利用(包括紧急情况)的关系 科室就诊、住院治疗、急症后或长期入住养老院。 目标2：确定非正式照顾者支助系统的力量是否与利用所有 卫生服务正在研究中，根据ADRD的地位和种族和族裔群体成员情况。 目标3：确定与ADRD的生活以及种族和民族群体成员身份如何与会议联系起来 自我确定的护理目标和以人为中心的结果，基于他们与HCBS相关的经验。 研究小组将向州医疗补助官员和其他相关利益相关者传播研究结果 如何最好地帮助患有ADRD的CHCPE客户避免或推迟不良健康后果，并实现自我 已确定的护理目标。传播活动还将包括在相关机构的年度会议上介绍情况 国家专业和科学组织以及相关同行评议期刊上的出版物。

Project Summary Many states are aggressively reforming their long-term services and supports systems by constraining the growth of nursing homes and expanding availability of home and community-based services (HCBS) through Medicaid waiver programs, which intend to maximize independent living for individuals at risk for nursing home care. Eligibility criteria for Medicaid HCBS waiver programs include financial and health-related factors, the latter which typically include functional and cognitive deficits. Medicaid HCBS waiver program populations of older adults across the states include individuals living at home with and without diagnosed Alzheimer's disease and related dementia (ADRD) as well as with a wide range of cognitive deficits even without a diagnosis of ADRD. ADRD is associated with many adverse health-related outcomes in population-based studies of community-dwelling older adults; however, whether and how ADRD and cognitive impairment severity are associated with adverse outcomes among older adults receiving services from Medicaid HCBS waiver programs is unknown. Little is known about the strength of informal caregiver support systems and their effects on adverse outcomes for older adults with and without dementia in HCBS programs. Success in meeting self-identified goals of care among older Medicaid HCBS waiver participants, and barriers to achieving these goals, have also not been explored in the context of having ADRD. Moreover, how race and ethnicity might modify effects in associations between ADRD, informal support systems, and health outcomes is unknown in this population. We propose to address these important and interrelated knowledge gaps guided by person-centeredness and health disparities conceptual frameworks. We will study a statewide population enrolled in Connecticut's Home Care Program for Elders (CHCPE), the Medicaid HCBS waiver program for older adults. CHCPE has a racially and ethnically diverse population, and State Medicaid policy decision-makers have expressed strong interest in improving dementia care for CHCPE participants. In Connecticut, a person-centered approach to care planning and implementation guides all Medicaid HCBS waiver program policies and practices. Specific aims guiding this study are to, in the CHCPE participant population: Aim 1: Determine how living with ADRD is associated with health service utilization, including emergency department visits, hospitalizations, and post-acute or long-term admission to nursing homes. Aim 2: Determine whether strength of the informal caregiver support system is associated with utilization of all health services under study, according to ADRD status and racial and ethnic group membership. Aim 3: Determine how living with ADRD, and racial and ethnic group membership, are associated with meeting self-identified goals of care and person-centered outcomes based on their HCBS-related experiences. The study team will disseminate findings to state Medicaid officials and other stakeholders concerned with how best to help CHCPE clients living with ADRD avoid or delay adverse health outcomes and achieve self- identified goals of care. Dissemination activities also will include presentations at annual meetings of relevant national professional and scientific organizations, and publications in relevant peer-reviewed journals.