Impact of the COVID-19 Pandemic on Patients with Alzheimer's Disease and Alzheimer's Disease Related Dementias

COVID-19 大流行对阿尔茨海默病和阿尔茨海默病相关痴呆症患者的影响

基本信息

批准号：
10423845
负责人：
JOHN HSU
金额：
$ 85.8万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-30 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10423845
关键词：
Accident and Emergency department Accounting Address Admission activity Advance Directives Adverse effects Affect Alzheimer disease detection Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Ambulances Ambulatory Care Ambulatory Care Facilities American Antipsychotic Agents Area Attention COVID-19 COVID-19 pandemic Caregivers Caring Censuses Cessation of life Clinical Code Cognitive Communities County Data Data Analytics Data Collection Data Set Death Certificates Delirium Diagnosis Disadvantaged Disease Disease Outbreaks Drug usage Elderly Electronic Health Record Emergency Situation Employment Equilibrium Ethnic Origin Event Future Goals Health Health system Healthcare Systems Hospitalization Hospitals Incidence Individual Infection Inpatients Intervention Link Low income Machine Learning Measures Medical Medicare Medicare claim Methodology Methods Modeling Natural experiment Nature Nursing Homes Outcome Outpatients Patient-Focused Outcomes Patients Pattern Patterns of Care Policies Population Race Reference Standards Regulation Reporting Research Resources Retirement Risk Factors SARS-CoV-2 infection Shock Social Distance Social isolation Social support Stress Surveys Symptoms System Time Travel Uncertainty United States National Institutes of Health Vaccination Validation Variant Viral Visit Vulnerable Populations Waxes Work adverse outcome aged base behavioral economics beneficiary care delivery cognitive function complex data coronavirus disease data resource disease transmission ethnic minority population flexibility frailty hospital readmission hospitalization rates improved inpatient service machine learning method mortality mortality risk older patient pandemic disease patient home care payment predictive modeling programs public health emergency racial and ethnic remote delivery remote health care response social social factors socioeconomic disadvantage telehealth time use

项目摘要

Abstract The COVID-19 pandemic has stressed health systems, caregivers, and patients for over a year. Hundreds of thousands have died, and millions more have been impacted by the threat of infection and efforts to mitigate disease spread. In response to these challenges, the Medicare program introduced emergency policies that permitted greater flexibility in the provision of outpatient and inpatient care, including relaxing rules governing the remote delivery of outpatient care and increasing hospital capacity. Unfortunately, there is limited information on how the changes in care delivery made possible by these temporary policies have impacted patient outcomes during times when viral spread and mitigation policies both waxed and waned. In this project, we will examine the impact of changes in outpatient and inpatient care on clinical event rates and deaths among older patients with Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD) living in the community. These patients are particularly vulnerable to social isolation or disruptions in their care, and might not be able to articulate their needs. Those with yet additional disadvantages such as frailty or lower incomes appear to have been even more susceptible to adverse effects of COVID-19 infections. Some care delivery changes, however, might have increased the number or quality of clinician interactions with patients, e.g., more frequent tele-health visits because of less need to travel. Thus, to examine the impact of the changes in care delivery under the emergency Medicare policies, we will address three aims: 1) To assess and refine study variable definitions given data collected during the pandemic; 2) To examine the impact of changes in outpatient care on clinical event rates, e.g., emergency department and hospitalization rates; and 3) To examine the impact of changes in inpatient care on mortality. Notably, changes in visit and referral patterns during the pandemic could impact information capture; thus, diagnosis-based definitions of AD/ADRD status, frailty, or delirium developed in the pre-pandemic era could be less accurate when using pandemic era data. We will examine these care patterns, assess the accuracy of claims-based measures, and develop prediction models using machine learning methods and linked, overlapping datasets; we also will account for temporal variation in documented COVID-19 infections and employment at the county level across all aims. Given these complex data and analytic issues, we will work with NIH’s Social, Behavioral, and Economic Research on COVID-19 Consortium to improve the data resources and methods for this type of work. The information from this large natural experiment is critical for preparing for future outbreaks or other shocks to the health system, to determine which of the emergency policies, if any, should be extended, and to inform debates concerning the balance between local flexibility and national standards within Medicare.

抽象的 COVID-19大流行使卫生系统，看护人和患者强调了一年多。数百个成千上万的人死亡，数以百万计的人受到感染威胁和减轻努力的影响疾病传播。为了应对这些挑战，Medicare计划提出了紧急政策在提供门诊和住院护理方面，允许更大的灵活性，包括统治的放松规则远程提供门诊护理和增加医院的能力。不幸的是，有限有关这些临时政策如何实现护理交付的变化的信息在病毒扩散和缓解政策均消失和减弱的时期，患者的结果。在这个项目中，我们将研究门诊和住院护理对临床事件发生率和死亡的影响在老年人患有阿尔茨海默氏病和阿尔茨海默氏病有关的痴呆症（AD/ADRD）的患者中在社区。这些患者特别容易受到社会隔离或护理中的干扰，并且也许无法表达他们的需求。那些有其他缺点的人，例如脆弱或较低收入似乎更容易受到共同19感染的不利影响。有些关心但是，分娩变化可能会增加与患者临床相互作用的数量或质量，例如，由于不需要旅行的需求较少，因此更频繁地进行远程健康访问。那是为了研究在紧急医疗保险政策下的护理交付变化，我们将解决三个目标：1）评估和在大流行期间收集的数据，精炼研究变量定义； 2）检查临床事件发生率（例如急诊室和住院率）的门诊护理变化；和 3）检查住院护理对死亡率的变化的影响。值得注意的是，访问和推荐的变化大流行期间的模式可能会影响信息捕获；因此，基于诊断的AD/ADRD定义在使用大流行时代时，在大流行时代发展的状态，脆弱或ir妄可能不准确数据。我们将检查这些护理模式，评估基于索赔的措施的准确性，并制定使用机器学习方法和链接的重叠数据集的预测模型；我们还将考虑所有目标的临时变异在县级别的Covid-19感染和就业。鉴于这些复杂的数据和分析问题，我们将与NIH的社会，行为和经济合作关于Covid-19联盟的研究，以改善此类工作的数据资源和方法。这来自这个大型自然实验的信息对于为将来的爆发或其他冲击做准备至关重要卫生系统，以确定应扩展哪些紧急政策（如果有），并告知关于当地灵活性与医疗保险国家标准之间的平衡的辩论。