iCAREFOR: Interhospital Care Fragmentation in Older Adults with Dementia

iCAREFOR：老年痴呆症患者的院际护理分散化

基本信息

批准号：
10451540
负责人：
Sara Diane Turbow
金额：
$ 15.14万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-15 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10451540
关键词：
Accident and Emergency department Acute Address Administrator Admission activity Age Aging Alzheimer&apos s Disease Alzheimer&apos s disease diagnosis Alzheimer&apos s disease related dementia Ambulances American Hospital Association Caring Clinical Code Computer software Continuity of Patient Care Data Data Analyses Databases Dementia Elderly Faculty Family Fee-for-Service Plans Foundations Funding Future Geriatrics Grant Health Health Disparities Research Health Professional Health Services Health Services Research Health Surveys Health care facility Health system Healthcare High Prevalence Hospital Mortality Hospitalization Hospitals ICD-9 Image Information Technology Inpatients Intervention Interview Investigation K-Series Research Career Programs Lead Link Location Medicare Mentorship Methods Mission Modeling Mollies National Institute on Aging Older Population Outcome Outpatients Patient-Focused Outcomes Patients Perception Persons Population Positioning Attribute Prevalence Protocols documentation Provider Qualitative Methods Quality of Care Questionnaires Research Research Personnel Resources Risk Factors Structure Surveys System Testing Time Training Universities Work acute care beneficiary care fragmentation certificate program cost data sharing dementia care design empowered experience health care settings health economics health record high risk hospital readmission human old age (65+)implementation science improved insight medical specialties metropolitan mortality mortality risk multidisciplinary novel strategies point of care policy implication prevent programs residence wasting

项目摘要

PROJECT SUMMARY When a patient is readmitted to a different hospital than the one they were previously discharged from, fragmentation of care occurs. Such fragmented readmissions are associated with a number of negative patient outcomes, including a nearly two-fold increased risk for mortality. Preliminary analyses by Dr. Sara Turbow, the PI for this grant, have shown that a diagnosis of Alzheimer’s disease and related dementias (ADRD) was an independent predictor of interhospital care fragmentation. In Aim 1, she will use Medicare data to estimate the association between inpatient fragmentation of care and either a) emergency department arrival via an ambulance or b) coming from a post-acute care facility. We hypothesize that ambulance use and post-acute care facility residence will contribute to the higher prevalence of interhospital care fragmentation in older adults with ADRD. In Aim 2, Dr. Turbow will examine the association between information sharing across hospitals and patient outcomes in older adults with ADRD by comparing fragmented readmissions between hospitals that share data via a health information exchange versus those that do not. In Aim 3, she will survey health professionals and interview health system leaders to ascertain critical barriers and facilitators to information sharing between healthcare settings. This proposal directly addresses the mission of the National Institute on Aging and of the National Plan to Address Alzheimer’s Disease, specifically to optimize care quality and efficiency for older adults with ADRD, and the applications of this research have implications for dementia care and health disparities research in ADRD. The proposed aims will be completed under the superlative mentorship of Dr. Mohammed K. Ali (expertise in health services research and implementation science), Dr. Camille Vaughan (expertise in aging/geriatrics research), Dr. Molly Perkins (expert in qualitative methods), Dr. Kimberly Rask (expert in health services research/health economics), and Dr. Steven Culler (Medicare data expert), as well as faculty at Emory’s Goizueta Alzheimer’s Disease Research Center. Emory University has ample resources to allow Dr. Turbow to carry out her research aims. Her training plan is structured to include formal didactic training at Emory and online via the UCSF Implementation Science Certification Program. The research aims and training plan will position Dr. Turbow to become an independently funded health services and aging researcher.

项目摘要当患者被录取到与以前的医院不同的医院时从护理的分裂出发。这种零散的再入院是相关的有许多负面的患者结局，包括增加近2倍的风险死亡。该赠款的PI Sara Turbow博士的初步分析表明阿尔茨海默氏病和相关痴呆症（ADRD）的诊断是独立的预测因子院间护理分裂。在AIM 1中，她将使用Medicare数据来估计护理的住院分裂与a）紧急部门到达通过救护车或b）来自急性后护理机构。我们假设救护车使用和急性后护理设施住宅将有助于较高的医院间患病率患有ADRD的老年人的护理分裂。在AIM 2中，Turbow博士将检查协会在医院之间的信息共享与ADRD老年人的患者结局之间通过比较通过健康共享数据的医院之间的零散的再入院信息交换与没有信息交换。在AIM 3中，她将调查卫生专业人员并采访卫生系统领导人确定信息的关键障碍和促进者在医疗机构之间共享。该提案直接解决了国家老龄化研究所和国家计划解决阿尔茨海默氏病的计划，特别是优化ADRD老年人的护理质量和效率研究对ADRD的痴呆症护理和健康差异研究具有影响。拟议的目标将根据博士的最高心态完成。 Mohammed K. Ali（健康服务研究与实施科学专业知识），博士卡米尔·沃恩（Camille Vaughan）（老龄化/老年研究专业知识），莫莉·珀金斯（Molly Perkins）博士（定性专家方法），金伯利·拉斯克（Kimberly Rask）博士（卫生服务研究/卫生经济学专家）和博士史蒂文·卡勒（Steven Culler）（医疗保险数据专家）以及埃默里（Emory 疾病研究中心。埃默里大学（Emory University）有足够的资源来允许Turbow博士携带她的研究目标。她的培训计划的结构是包括在Emory的正式教学培训并通过UCSF实施科学认证计划在线。研究的目的是培训计划将使Turbow博士成为一家独立资助的卫生服务，并老化的研究人员。