A Longitudinal Network Study of Alzheimer's and Dementia Care in Relation to Disparities in Access and Outcomes

阿尔茨海默病和痴呆症护理与获取和结果差异相关的纵向网络研究

• 批准号: 9562244
• 负责人: Jacqueline Merrill
• 金额: $ 82.41万
• 依托单位: VISITING NURSE SERVICE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-30 至 2018-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9562244
• 关键词: Address; Admission activity; Affect; Alzheimer' s Disease; Ambulatory Care; Area; Caring; Categories; Characteristics; Chronic; Chronic Care; Clinical assessments; Cognitive; Communities; Complex; Data; Data Set; Decubitus ulcer; Dehydration; Dementia; Diagnosis; Diagnostic; Disease; Disease Outcome; Elderly; Environment; Ethnic Origin; Family Caregiver; Frequencies; Geography; Goals; Health; Health Services Accessibility; Healthcare; Home Care Services; Home environment; Hospitalization; Impaired cognition; Improve Access; Individual; Infection; Intervention; Knowledge; Language; Link; Longitudinal cohort study; Maps; Medicare/Medicaid; Methods; Neighborhoods; New York; Nursing Homes; Nursing Services; Outcome; Pathway Analysis; Patient Care; Patients; Pattern; Patterns of Care; Population; Prevalence; Provider; Public Health; Race; Recommendation; Research; Research Personnel; Resources; Risk; Sampling; Science; Services; Socioeconomic Status; Statistical Data Interpretation; System; Techniques; Testing; Urban Population; Visiting Nurse; adverse outcome; base; burden of illness; cohort; community based service; dementia care; disparity reduction; experience; falls; health care service; health disparity; hospice environment; improved; innovation; insight; patient home care; programs; racial and ethnic; racial and ethnic disparities; response; socioeconomic disparity; socioeconomics

PROJECT SUMMARY/ABSTRACT Alzheimer's disease and related dementias (AD/dementia) represent a looming public health crisis, affecting roughly 5 million people in the U.S. and 11% of older adults. As with other chronic conditions, racial/ethnic and socio-economic disparities exist in the prevalence and burden of illness. However, less is known about how disparities in access to care influence the care trajectories – i.e. the scope, frequency and sequence of services used across health care settings – of those with AD/dementia. This retrospective, longitudinal cohort study will address this gap by using network analysis to examine care trajectories and outcomes in a racially and socioeconomically diverse sample of community-dwelling individuals with AD/dementia and unspecified cognitive impairment (CI) who may be at risk for a delayed AD/dementia diagnosis. The cohort will consist of home health care patients served by the Visiting Nurse Service of New York (VNSNY), a large, non-profit home care provider. Data will include clinical assessments for roughly 89,000 patients admitted to home care during 2010-2012 linked with 4 years of Medicare and Medicaid claims data and geographic data on neighborhood services. The specific aims are to: (1) Describe the population at VNSNY within two diagnostic categories (AD/dementia and unspecified CI) in relation to adverse outcomes (e.g. pressure ulcers, falls, infection, dehydration, preventable hospitalization, and nursing home admission); (2) Map, quantify and compare patterns in the care trajectories of individuals and groups that experience variable and/or disparate outcomes; and (3) Identify strategies for implementing care trajectories with potential to reduce disparities in access and/or outcomes for AD/dementia and unspecified CI. Applying a systems science framework, the study will use innovative network analytics to capture complex patterns in care trajectories that may contribute to adverse outcomes in a racially and socioeconomically diverse sample of individuals with these two conditions. The long-term goal of this research is to identify and, in subsequent studies, test potential home- and community-based interventions that may improve access to services and outcomes for individuals who may be underserved or at heightened risk for unmet healthcare needs. This research will produce new knowledge to aid efforts to mitigate health disparities in this vulnerable and growing population.

项目概要/摘要 阿尔茨海默氏病和相关痴呆症（AD/痴呆）代表着迫在眉睫的公众 健康危机影响了美国约 500 万人和 11% 的老年人。 慢性病的患病率和种族/族裔以及社会经济差异存在 然而，人们对于获得医疗服务的差异如何影响疾病负担却知之甚少。 护理轨迹——即整个医疗保健中使用的服务的范围、频率和顺序 这项回顾性纵向队列研究将针对 AD/痴呆症患者的环境进行研究。 通过使用网络分析来检查种族和群体中的护理轨迹和结果来弥补这一差距 患有AD/痴呆症的社区居民的社会经济多样化样本 可能有延迟 AD/痴呆诊断风险的未明确认知障碍 (CI)。 该队列将由新的访问护士服务中心服务的家庭保健患者组成 York (VNSNY) 是一家大型非营利性家庭护理提供商，数据将包括临床评估。 2010 年至 2012 年期间，约有 89,000 名患者接受家庭护理，并接受了 4 年的治疗 医疗保险和医疗补助索赔数据和邻里服务的地理数据。 具体目标是： (1) 根据两个诊断类别（AD/痴呆症）描述 VNSNY 的人口 和未指定的 CI）与不良后果（例如压疮、跌倒、感染、 脱水、可预防的住院治疗和入住疗养院）； (2) 绘制、量化和比较个人和群体的护理轨迹模式 经历可变和/或不同的结果；和 (3) 确定实施可能减少的护理轨迹的策略 AD/痴呆和未明确的 CI 的获取和/或结果存在差异。 该研究将应用系统科学框架，利用创新的网络分析来 捕捉护理轨迹中可能导致不良结果的复杂模式 具有这两种情况的个体的种族和社会多样性样本。 这项研究的长期目标是确定并在后续研究中测试潜在的家庭和 基于社区的干预措施可以改善人们获得服务的机会和结果 可能得不到充分服务或因医疗保健需求未得到满足而面临卫生风险的个人。 研究将产生新知识，以帮助努力缩小这方面的健康差距 弱势群体和不断增长的人口。

项目成果

Clinical and Demographic Profiles of Home Care Patients With Alzheimer's Disease and Related Dementias: Implications for Information Transfer Across Care Settings.

• DOI: 10.1177/0733464821999225
• 发表时间: 2022-03
• 期刊: Journal of applied gerontology : the official journal of the Southern Gerontological Society
• 作者: Ryvicker M;Barrón Y;Shah S;Moore SM;Noble JM;Bowles KH;Merrill J
• 通讯作者: Merrill J