Effect of Hospital and Community Care Coordination on Health Care Quality and Equity among Individuals with Risk Factors or Diagnosis of ADRD

项目摘要：通过当地公众的融合解决ADRD中的种族和民族差异 卫生部门和卫生系统是一个战略优先事项，根据国家计划，以解决 阿尔茨海默病2019预计这种整合将解决健康的社会决定因素， 文化上有效的人口健康评估和治疗。对护理协调做法的投资， 创新的医疗保健提供模式，如责任医疗组织（ACO），代表了一个 这是促进ADRD患者和ADRD风险因素持续护理的重要机会。有 迫切需要了解种族和少数民族ADRD患者的有效护理协调实践 医院、社区和公共卫生系统之间的协调，以及如何系统地改善这种协调 通过创新的医疗保健提供模式。我们的长期目标是建立一个医院-社区一体化 提供个性化的以患者为中心的护理，以促进人口健康和减少健康 ADRD患者和ADRD风险因素的差异。该项目的目标是确定医院- 社区护理协调实践和卫生保健提供模式的创新特征， 改善ADRD的有效管理;控制/减少可改变的风险因素;并最终促进 人口健康和减少健康差距。我们的中心假设是，整合医院和 在现行政策倡议的支持下开展社区护理，促进采取护理协调办法， 例如ACO，可以显著提高医疗质量和公平性。我们特别感兴趣的是 了解护理协调如何提高少数种族和族裔的护理质量。额外 感兴趣的人群是最难接触到的人群：接受治疗的少数种族和民族 联邦住房援助（通过住房和城市发展部（HUD））， 经历过无家可归的时期我们的目标是确定医院-社区护理协调做法 能够提高医疗质量、降低医疗成本、减少种族和民族差异的措施（目标1）; 确定ACO模式在多大程度上可以促进护理协调实践并减少差异 在患有ADRD的医疗保险受益人和ADRD风险增加的受益人中（目标2）; 评估护理协调实践和ACO模式对医疗质量和差异的影响 在接受HUD治疗的ADRD人群和ADRD风险增加的人群中， ADRD（目标3）。我们的目标是根据我们在目前的NIA下产生的初步研究结果制定的 支持（R56 AG 062315）。我们的研究结果有望为成本效益的护理提供证据 协调做法，使少数种族和族裔人口的护理一体化可持续， 打破长期存在的孤岛，弥合医院、医疗保健提供者和公众之间的差距 ADRD患者的卫生系统和ADRD的危险因素。

Project Summary: Addressing racial and ethnic disparities in ADRD through the integration of local public health departments and health systems is a strategic priority, according to The National Plan to Address Alzheimer's Disease 2019. Such integration is expected to address social determinants of health and promote culturally-valid population health assessments and treatment. Investments in care coordination practices and innovative health care delivery models, such as Accountable Care Organizations (ACOs), represent an important opportunity for promoting continuity of care for people with ADRD and risk factors for ADRD. There is an urgent need to understand effective care coordination practices for racial and ethnic minority ADRD patients across hospital, community, and public health systems, and how to improve such coordination systematically through innovative health care delivery models. Our long-term goal is to build a hospital-community integrated system that delivers personalized patient-centered care to promote population health and reduce health disparities for people with ADRD and risk factors for ADRD. The objective of this project is to identify hospital- community care coordination practices and the innovative features of health care delivery models that can improve effective management of ADRD; control/reduce modifiable risk factors of; and eventually promote population health and reduce health disparities. Our central hypothesis is that integrating hospital and community care with the support of ongoing policy initiatives that promote the adoption of care coordination, such as ACOs, can significantly improve health care quality and equity. We are particularly interested in understanding how care coordination can improve care quality for racial and ethnic minorities. An additional population of interest is among the hardest-to-reach populations: racial and ethnic minorities who receive federal housing assistance (through the Department of Housing and Urban Development (HUD)) and who may have experienced periods of homelessness. We aim to identify hospital-community care coordination practices that can improve quality of care, reduce health care costs, and reduce racial and ethnic disparities (Aim 1); determine the extent to which ACO models can promote care coordination practices and reduce disparities among Medicare beneficiaries with ADRD and beneficiaries who are at an increased risk for ADRD (Aim 2); and estimate the impact of care coordination practices and ACO models on health care quality and disparities reduction among HUD-assisted populations with ADRD and populations who are at an increased risk for ADRD (Aim 3). Our aims are formulated on the basis of our preliminary findings produced under current NIA support (R56AG062315). The results of our study are expected to provide evidence on cost-effective care coordination practices that can make care integration sustainable for racial and ethnic minority populations, and break down longstanding silos and bridge the gap between hospitals, health care providers, and the public health system for people with ADRDs and risk factors of ADRDs.