R01 Upstream Approaches to Improve Late Life Care for People Living with Dementia

项目总结 长期目标是提高为阿尔茨海默病患者家庭和患者提供的临终关怀的质量。 海默氏病及其相关痴呆症(痴呆症)--通过生成关于公众的人口水平证据 社区支持结构的健康影响，包括熟练的家庭保健。阿尔茨海默病 预计到2030年，种族和少数民族人口的诊断率将增加一倍以上。庞大的种族和 在完善的临终关怀质量指标中存在种族差异和差异(住院患者敬佩- 疾病、临终关怀用途、死亡地点)，而在痴呆症患者中，这些差异可能存在- 受到重创。改善种族/少数民族和社会生态的痴呆症护理的一种未被研究的方法 名义上处于不利地位的人口是使用熟练的家庭保健(这是联邦医疗保险和 医疗补助)。本R01的短期目标是确定熟练家庭的影响中的种族/民族差异 关于临终关怀质量指标的保健服务(例如，住院人数、临终关怀的使用情况和地点 死亡)作为痴呆症诊断的一项功能。中心假设是“上游”接触家庭健康 在生命的最后一年之前和期间的护理对“下游”临终有累积和有益的影响 护理质量指标：(1)住院人数，(2)临终关怀利用率，(3)死亡地点。科学的 这项工作的前提是PLWD有复杂的医疗和行为健康需求，许多人依赖FAM- 照顾者帮助日常生活活动和医疗护理的协调。从熟练技能中受益的人太少 家庭健康护理。随着认知功能的恶化，从轻微的症状和行为改变到更多的AD 先进的疾病，熟练的家庭保健可能有助于防止本可避免的住院，并将负担降至最低- 在临终关怀环境中的一些过渡。核心假说将通过追逐三个 具体目标：检查在接受熟练的家庭保健之前和在最后一次期间之间的关系 生命年份和：1)生命最后一年的住院次数(类型、频率和时间)，2)临终关怀利用情况- 生命最后一年的死亡(时间和环境)以及3)死亡地点(例如，医院、家庭、医院的临终关怀， 在家中的临终关怀)。AIMS将使用关联的医疗保险数据集进行测试，以检查技能培训的效果 家庭卫生保健利用对被诊断为临终结局的种族和民族差异的影响 与未被诊断为痴呆症的人相比，患有痴呆症的人。这项申请中提出的研究是 在申请人看来，这是一种创新，因为它侧重于评估未得到充分利用的医疗和医疗服务的核心效益。 通过评估熟练的家庭保健获得对痴呆症护理质量差异的影响。 成功完成提案目标将通过提供所需的和 减少照顾患有痴呆症的种族和少数族裔老年人方面的差距的可行证据。 该项目将对国际人口卫生系统的设计、开发和评估产生重大影响。 消除或减少痴呆症患者在护理和临终结局方面的差距的发明。

PROJECT SUMMARY The long-term goal is to improve the quality of end-of-life care provided to families and people living with Alz- heimer’s disease and its related dementias (dementia) by generating population-level evidence on the public health impact of community-based support structures including skilled home health care. Alzheimer’s Disease diagnosis in racial and ethnic minority populations is projected to more than double by 2030. Large racial and ethnic differences and disparities exist in well-established end-of-life care quality indicators (inpatient admis- sions, hospice use, place of death), and in people living with dementia some of these differences may be com- pounded. One understudied approach to improving dementia care among racial/ethnic minority and socioeco- nomically disadvantaged populations is the use of skilled home health care (a benefit under Medicare and Medicaid). The short-term goal for this R01 is to define racial/ethnic differences in the effects of skilled home health care on indicators of end-of-life care quality (e.g., inpatient admissions, use of hospice, and place of death) as a function of dementia diagnosis. The central hypothesis is that “upstream” exposure to home health care prior to and during the final year of life has a cumulative and beneficial effect on "downstream” end-of-life care quality indicators: (1) inpatient admissions, (2) hospice utilization, and (3) place of death. The scientific premise for this work is that PLwD have complex medical and behavioral health needs, and many rely on fam- ily caregivers to help with activities of daily living and coordination of medical care. Too few benefit from skilled home health care. As cognitive function deteriorates from mild symptoms and behavioral changes to more ad- vanced illness, skilled home health care may help prevent avoidable hospitalizations, and minimize burden- some transitions across care settings at the end-of-life. The central hypothesis will be tested by pursing three specific aims: Examine the relationship between receiving skilled home health care prior to and during the last year of life and: 1) inpatient admissions (type, frequency and length) in the last year of life, 2) hospice utiliza- tion (timing and setting) in the last year of life, and 3) place of death (e.g., hospital, home, hospice in a hospital, hospice at home). The aims will be tested using linked Medicare data sets to examine the effect of skilled home health care utilization on racial and ethnic disparities in end-of-life outcomes among people diagnosed with dementia compared to people not diagnosed with dementia. The research proposed in this application is innovative, in the applicant’s opinion, because it focuses on evaluating an underutilized core benefit of Medi- care through evaluating the effect of skilled home health care access on disparities in dementia care quality. Successful completion of proposal aims will have a sustained and powerful impact by providing needed and actionable evidence to reduce disparities in care for racial and ethnic minority older adults living with dementia. The project will significantly impact the design, development, and evaluation of population health system inter- ventions to eliminate or reduce disparities in care and end-of-life outcomes among people living with dementia.