iCAREFOR: Interhospital Care Fragmentation in Older Adults with Dementia

iCAREFOR：老年痴呆症患者的院间护理分散化

基本信息

批准号：
10231249
负责人：
Sara Diane Turbow
金额：
$ 15.17万
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/10231249
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 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 disparity 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.

项目概要当患者重新入院到与之前所在医院不同的医院时出院后，护理的碎片化会发生这种碎片化的再入院。带来许多负面的患者结果，包括患病风险增加近两倍此项资助的首席研究员 Sara Turbow 博士的初步分析表明，阿尔茨海默病和相关痴呆症 (ADRD) 的诊断是一个独立的预测因素在目标 1 中，她将使用 Medicare 数据来估计医院间护理的分散程度。住院患者护理分散与 a) 急诊室到达之间的关联通过救护车或 b) 来自急性后护理机构。使用和急性后护理机构的居住将导致院间感染的发生率更高在目标 2 中，Turbow 博士将研究这种关联。医院间的信息共享与患有 ADRD 的老年人的患者结果之间的关系通过比较通过健康信息共享数据的医院之间的零散再入院情况在目标 3 中，她将调查卫生专业人员。并采访卫生系统领导者以确定信息的关键障碍和促进因素该提案直接解决了医疗保健机构之间的共享问题。国家老龄化研究所和解决阿尔茨海默病国家计划，特别是优化患有 ADRD 的老年人的护理质量和效率，及其应用研究对 ADRD 中的痴呆症护理和健康差异研究具有影响。拟议的目标将在博士的最高指导下完成。 Mohammed K. Ali（卫生服务研究和实施科学方面的专家），Dr. Camille Vaughan（衰老/老年医学研究专家）、Molly Perkins 博士（定性专家）方法）、Kimberly Rask 博士（卫生服务研究/卫生经济学专家）和 Dr. Steven Culler（医疗保险数据专家）以及埃默里大学 Goizueta 阿尔茨海默氏症的教员埃默里大学疾病研究中心有充足的资源让 Turbow 博士携带。她的培训计划包括在埃默里大学的正式教学培训。并通过加州大学旧金山分校实施科学认证计划在线进行。培训计划将使 Turbow 博士成为独立资助的卫生服务机构和老龄化研究员。