The impact of facility characteristics on racial disparities in ADRD mortality in nursing homes

设施特征对疗养院 ADRD 死亡率种族差异的影响

基本信息

批准号：
10538328
负责人：
Michelle Anne DeVost
金额：
$ 3.86万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-01 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10538328
关键词：
Accounting Adult Affect Age Aging Alzheimer&apos s Disease Alzheimer&apos s disease care Alzheimer&apos s disease diagnosis Alzheimer&apos s disease related dementia Attention Back Black race COVID-19 pandemic California Caring Censuses Cessation of life Characteristics Chronic Competence Data Data Set Data Sources Detection Development Diagnosis Elderly Epidemiologic Methods Epidemiology Ethnic Origin Excess Mortality Foundational Skills Goals Health Health Disparities Research Health Policy Health Services Health Services Accessibility Home Nursing Care Hour Inequality Institutional Racism Knowledge Latinx Link Mentors Mentorship Methodology Methods Mission Modeling Mortality Determinants National Research Service Awards Nurses Nursing Homes Outcome Persons Policies Population Positioning Attribute Predisposition Prevalence Public Health Quality of Care Race Registries Research Research Personnel Risk Safety Series Source Stress Structural Racism Subgroup System Time Training United States United States Centers for Medicare and Medicaid Services Update Variant Vulnerable Populations Work analytical method body system care delivery career comorbidity doctoral student experience health care delivery health equity health inequalities high risk human old age (65+)improved innovation insight mortality mortality disparity mortality risk multiple chronic conditions pandemic disease population health pressure racial disparity segregation skills social social epidemiology social inequality stressor time use

项目摘要

PROJECT SUMMARY/ABSTRACT This mentored Ruth L. Kirschstein National Research Service Award will provide the trainee, a PhD student in epidemiology at UCSF, necessary training in social inequalities in nursing home (NH) care delivery, determinants of mortality risk for older adults with Alzheimer’s disease and Alzheimer’s disease related dementias (AD/ADRD), and quantitative skills for analyzing and accounting for bias in large administrative datasets. Guided by a team of expert mentors, the trainee will gain the skills, practical experience, and knowledge to launch a successful academic research career dedicated to the application of rigorous epidemiologic methods to study the social systems of aging and health services in the context of ongoing social inequity, health inequality, and institutional and structural racism. The COVID-19 pandemic heightened the burden on NHs and increased variation in facility characteristics including staffing ratios and average nurse hours per resident day. The resulting systemic stress can highlight institutional drivers of long-standing health inequities among NH residents with AD/ADRD by race/ethnicity. While large racial inequalities in excess mortality occurred during the COVID-19 pandemic, the determinants of these inequalities—particularly among NH residents living with AD/ADRD—are not known. Prior studies of excess mortality in NHs have not explored the effects of time-varying, policy-relevant variables like NH occupancy and staffing characteristics. Building on prior work of the trainee, this F31 uses linked administrative datasets including comprehensive mortality data for the state of California and NH facility data from the Centers for Medicare and Medicaid Services to: (Aim 1) estimate pandemic-era excess mortality overall and stratified by race/ethnicity among all NH residents, NH residents with AD/ADRD, and multimorbid NH residents with AD/ADRD, and (Aim 2) identify time-invariant and time-varying facility/staffing characteristics linked to excess mortality and racial disparities in excess mortality in these populations. This analysis will deliver policy- relevant evidence on NH characteristics that put older adults at risk and fulfill the candidate’s training aims to position her for ongoing research to improve the lives of Black and Latinx older adults with AD/ADRD living in NHs. This proposal’s major strengths are: (1) a state-level census of mortality in California dating back to 2016; (2) longitudinal census data of all NH facilities in California over the same period; and (3) innovative hypotheses focusing on gaps in health equity research for highly vulnerable older adults. Knowledge gained from this research will advance the NIA’s mission to identify and evaluate structural factors that produce disparities in quality and access to care in old age. Guided by an exemplary mentorship team, the proposed training will enhance the applicant’s methodological skills, research competency, and content expertise needed for her career as an independent academic researcher focused on improving health equity for older adults.

项目概要/摘要这个由露丝·L·基尔施斯坦（Ruth L. Kirschstein）指导的国家研究服务奖将为实习生，一名博士生提供加州大学旧金山分校的流行病学、疗养院 (NH) 护理服务中社会不平等的必要培训、患有阿尔茨海默病的老年人死亡风险的决定因素以及阿尔茨海默病相关的痴呆症（AD/ADRD），以及分析和解释大型行政偏见的定量技能在专家导师团队的指导下，学员将获得技能、实践经验和致力于应用严谨的知识开展成功的学术研究生涯在持续的背景下研究老龄化社会系统和卫生服务的流行病学方法社会不平等、健康不平等以及制度性和结构性种族主义。 COVID-19 大流行给 NH 带来了负担，并增加了设施特征的变化包括人员配置比例和住院医师每天的平均护士工作时间，由此产生的系统性压力可以凸显出来。 NH 居民中按种族/族裔划分的 AD/ADRD 患者长期健康不平等的制度驱动因素。尽管在 COVID-19 大流行期间出现了死亡率过高的严重种族不平等现象，但这些不平等现象，尤其是患有 AD/ADRD 的新罕布什尔州居民，此前的研究尚不清楚。 NH 中的超额死亡率尚未探讨 NH 等随时间变化的政策相关变量的影响该 F31 基于受训者之前的工作，使用关联的管理。数据集包括加利福尼亚州的综合死亡率数据和来自新罕布什尔州的设施数据医疗保险和医疗补助服务中心：（目标 1）估计大流行时代总体超额死亡率，并按种族/族裔对所有 NH 居民、患有 AD/ADRD 的 NH 居民以及患有多病的 NH 居民进行分层与 AD/ADRD，以及（目标 2）识别与相关的时不变和时变设施/人员特征该分析将提供政策指导。有关将老年人置于危险之中的 NH 特征的相关证据，并实现候选人的培训目标让她参与正在进行的研究，以改善生活在 AD/ADRD 的黑人和拉丁裔老年人的生活 NHs。该提案的主要优点是：（1）加州2016年的州级死亡率普查； (2) 同期加州所有 NH 设施的纵向普查数据；以及 (3) 创新性数据；假设侧重于高度弱势老年人的公平健康研究的差距获得的知识。这项研究将推进 NIA 的使命，即识别和评估产生的结构性因素在模范指导团队的指导下，提出了解决老年护理质量和获取机会方面的差异的问题。培训将提高申请人的方法技能、研究能力和所需的内容专业知识表彰她作为一名独立学术研究员的职业生涯，专注于改善老年人的健康公平。