The Influence of Primary Care Structural Capabilities on Hospitalizations among Older Adults with Dementia

初级保健结构能力对老年痴呆症患者住院治疗的影响

• 批准号: 10190498
• 负责人: Vaneh Elena Hovsepian
• 金额: $ 4.82万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-06-15 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10190498
• 关键词: Administrative Supplement; Administrator; Admission activity; Affect; Age-Years; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Award; Caring; Chronic Care; Chronic Disease; Clinical; Communities; Community Integration; Data; Degenerative Disorder; Delirium; Dementia; Drug Prescriptions; Elderly; Electronic Health Record; Funding; Gastrointestinal Diseases; Health; Health Services; Healthcare; Hospitalization; Hospitals; Individual; Knowledge; Length of Stay; Linear Regressions; Link; Medicare; Medicare claim; Medication Management; Mentors; Mission; Modeling; Morbidity - disease rate; Myocardial Ischemia; National Institute on Aging; Nurse Practitioners; Nurses; Nursing Homes; Outcome; Patient-Focused Outcomes; Patients; Physician Assistants; Physicians; Pneumonia; Policy Maker; Population; Primary Care Physician; Primary Health Care; Principal Investigator; Quality of Care; Research; Research Personnel; Resources; Sampling; Scientist; Structure; Surveys; System; Time; United States; United States National Institutes of Health; beneficiary; burden of illness; care coordination; care delivery; care providers; cost effective; data management; disabling disease; doctoral student; experience; falls; health care service utilization; human old age (65+); improved; meetings; mortality; pre-doctoral; primary care setting; programs; response; skills

Currently, 5.8 million Americans have Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD). As the segment of the United States population age 65 and older continues to grow, the number of Americans with AD/ADRD and the use of health care services such as hospitalizations will also increase. Hospitalizations are more prevalent among older adults with AD/ADRD compared to older adults without AD/ADRD. Some of these hospitalizations are considered potentially avoidable if individuals have better access to and quality of primary care. However, delivering high quality primary care is becoming increasingly challenging given the projected shortage of primary care physicians. On the other hand, the number of nurse practitioners (NPs) has grown in the recent years and will increase by 93% by 2025. Further, NPs deliver high- quality and cost-effective care to older adults. Yet, little is known about how to support NPs' ability to deliver high quality care. Particularly, little is known about how to strengthen structural capabilities, essential practice features needed for delivering high quality of care, in practices where NPs provide care to older adults with AD/ADRD. Enhancing primary care delivery through strengthening structural capabilities such as care coordination, the Electronic Health Record (EHR), and community integration in primary care can be an effective potential way to reduce hospitalizations among older adults with AD/ADRD. The overall objective of the proposed study is to assess the effects of primary care structural capabilities in practices employing NPs on both all-cause and potentially avoidable hospitalizations among Medicare beneficiaries with AD/ADRD. This dissertation study will use unique cross-sectional data produced in 2018-2019 from a large National Institutes of Health-funded study and its associated Alzheimer's supplement (PI: Poghosyan, R01 MD011514-03S1). The following specific aims are proposed: Aim 1. Describe structural capabilities (i.e., availability of care coordination, EHR, and community integration) in primary care practices where NPs provide care to Medicare beneficiaries with AD/ADRD. Aim 2. Assess the impact of structural capabilities in primary care practices employing NPs on potentially avoidable and all-cause hospitalizations among Medicare beneficiaries with AD/ADRD. We hypothesize that more structural capabilities will be associated with lower hospitalizations among Medicare beneficiaries with AD/ADRD compared to practices with fewer structural capabilities. Multi- level linear regression models will be used to assess the impact of structural capabilities on hospitalizations among older adults with AD/ADRD. Findings from this study will generate evidence about how structural capabilities may improve primary care delivery for older adults with AD/ADRD. The proposed study is well- aligned with the mission of the National Institute of Aging to identify ways to reduce illness burdens such as hospitalizations among those with AD/ADRD. In addition, this R36 study will allow a pre-doctoral student to develop the skills needed to become an independent health services researcher.

目前，580万美国人患有阿尔茨海默病和阿尔茨海默病相关痴呆症 （AD/ADRD）。随着美国 65 岁及以上人口的持续增长， 患有 AD/ADRD 的美国人的数量以及住院等医疗保健服务的使用也会增加。 与没有 AD/ADRD 的老年人相比，住院治疗在患有 AD/ADRD 的老年人中更为普遍 AD/ADRD。如果个人有更好的情况，其中一些住院治疗被认为是可以避免的 获得初级保健的机会和质量。然而，提供高质量的初级保健正变得越来越重要 鉴于预计初级保健医生短缺，这具有挑战性。另一方面，护士数量 近年来，从业者 (NP) 不断增长，到 2025 年将增加 93%。此外，NP 提供高 为老年人提供优质且具有成本效益的护理。然而，人们对如何支持 NP 的交付能力知之甚少。 高质量的护理。特别是对于如何加强结构能力、基本实践知之甚少 在 NP 为老年人提供护理的实践中，提供高质量护理所需的功能 AD/ADRD。通过加强护理等结构能力来加强初级保健服务 初级保健中的协调、电子健康记录 (EHR) 和社区整合可以成为 减少患有 AD/ADRD 的老年人住院的有效潜在方法。总体目标 拟议的研究旨在评估初级保健结构能力在使用 NP 的实践中的影响 患有 AD/ADRD 的 Medicare 受益人的全因住院和可能避免的住院治疗。这 论文研究将使用大型国家研究所 2018-2019 年生成的独特横截面数据 健康资助的研究及其相关的阿尔茨海默病补充剂（PI：Poghosyan，R01 MD011514-03S1）。 提出了以下具体目标： 目标 1. 描述结构能力（即护理的可用性） NP 向 Medicare 提供护理的初级护理实践中的协调、EHR 和社区整合） 患有 AD/ADRD 的受益人。目标 2. 评估结构能力对初级保健实践的影响 在 Medicare 受益人中雇用 NP 来处理可能可以避免的和全因住院的情况 AD/ADRD。我们假设更多的结构能力将与更低的住院率相关 与结构能力较差的实践相比，患有 AD/ADRD 的医疗保险受益人的情况。多- 水平线性回归模型将用于评估结构能力对住院治疗的影响 患有 AD/ADRD 的老年人。这项研究的结果将产生关于结构如何 能力可以改善患有 AD/ADRD 的老年人的初级保健服务。拟议的研究很好—— 与国家老龄化研究所的使命相一致，寻找减轻疾病负担的方法，例如 AD/ADRD 患者的住院情况。此外，这项 R36 研究将使博士生能够 培养成为独立卫生服务研究员所需的技能。

项目成果

The Impact of Ambulatory Dementia Care Models on Hospitalization of Persons Living With Dementia: A Systematic Review.

门诊痴呆症护理模式对痴呆症患者住院的影响：系统评价。

• 发表时间: 2022
• 影响因子: 2.6
• 作者: Hovsepian, Vaneh;Bilazarian, Ani;Schlak, Amelia E;Sadak, Tatiana;Poghosyan, Lusine
• 通讯作者: Poghosyan, Lusine