The Impact of Advanced Practice Clinicians on End of Life Outcomes for Older Adults with Dementia

高级实践临床医生对痴呆症老年人临终结局的影响

基本信息

批准号：
10341076
负责人：
Md Momotazur Rahman
金额：
$ 48.99万
依托单位：
BROWN 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：
2020-01-15 至 2023-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10341076
关键词：
Acute Address Admission activity Advance Care Planning Alzheimer&apos s Disease Alzheimer&apos s disease related dementia Caregivers Caring Censuses Cessation of life Characteristics Client satisfaction Communities Country Coupled Cross-Sectional Studies Data Dementia Do Not Resuscitate Order Effectiveness Elderly Enteral Feeding Exposure to Face Family Fee-for-Service Plans Geographic state Goals Health Personnel Health system Hospitalization Hospitals Individual Intensive Care Units Intervention Knowledge Life Link Literature Location Managed Care Medicaid Medical Medically Underserved Area Medicare Medicare claim Minority Modeling National Institute on Aging Nurse Practitioners Nursing Homes Outcome Outpatients Palliative Care Patient Care Patients Persons Pharmaceutical Preparations Physician Assistants Physicians Play Policies Population Primary Care Physician Primary Health Care Provider Quality of Care Regulation Research Resources Rights Role Safety Schools Services Testing Training Work acute care base beneficiary care systems community setting demographics design dual eligible end of life end of life care health care service organization hospice environment improved recruit reduce symptoms rural underserved skills

项目摘要

ABSTRACT Individuals with Alzheimer’s disease and related dementias (ADRD) often face hospitalizations and other burdensome interventions at end of life that could be avoided with better preemptive medical care – specifically, early recognition and treatment of acute illness, improved advance care planning and palliative care, and availability of resources to manage acute conditions in the outpatient setting. Nurse practitioners and physician assistants, collectively known as advanced practice clinicians (APCs), are playing an increasingly important role in the medical management of older adults in both nursing home and community settings, yet little is known about how these clinicians influence end of life outcomes for people with ADRD under traditional fee-for-service Medicare. Additionally, APC scope of practice is governed by state regulations which vary considerably and it is unknown how these regulations impact the provision of end of life care to people with ADRD, particularly those living in rural or medically underserved areas. The long-term goal of this research is to develop evidence that will inform workforce planning and policy efforts to provide high quality care to people with ADRD at end of life. Our central hypotheses are that APCs provide services to vulnerable sub-populations of people with ADRD who may otherwise have poor access to quality end of life care; and that the involvement of APCs in care reduces the likelihood of being exposed to burdensome interventions at end of life. To test these hypotheses, we propose a cross-sectional study using 2015-2018 Medicare claims and administrative data with the following specific aims: (1) To describe population and state regulatory characteristics associated with people with ADRD receiving care from APCs at end of life; (2) To evaluate whether APC care is associated with acute care utilization in the last month of life, death in a hospital, hospice utilization, and feeding tube placement for people with ADRD; and (3) To evaluate whether the effects of APC care on end of life outcomes vary across states with different scope of practice regulations. This will be the first study to examine the impact of APCs on end of life outcomes for individuals with ADRD, or for any population of Medicare beneficiaries. Findings from this study will inform staffing composition for nursing homes, physician practices, and other healthcare organizations that care for people with ADRD; provide guidance to state policymakers who design APC scope of practice regulations; and inform workforce planning, training, and recruitment efforts for schools and healthcare organizations.

抽象的患有阿尔茨海默氏病和相关痴呆症 (ADRD) 的人经常面临住院治疗和其他治疗通过更好的先发性医疗护理可以避免生命末期繁重的干预措施 – 具体而言，早期识别和治疗急性疾病、改进预先护理计划和姑息治疗护理人员以及管理门诊急症的资源的可用性。医师助理，统称为高级实践指挥官（APC），正在发挥越来越大的作用在疗养院和社区环境中老年人的医疗管理中发挥着重要作用，但人们对这些偏爱的因素如何影响传统治疗下 ADRD 患者的临终结局知之甚少。此外，APC 的业务范围受各州法规的管辖，各州法规有所不同。相当大，目前尚不清楚这些法规如何影响向患有此病的人提供临终关怀 ADRD，特别是那些生活在农村或医疗服务匮乏地区的人这项研究的长期目标是。收集证据，为劳动力规划和政策努力提供信息，为人们提供高质量的护理我们的中心假设是 APC 为弱势群体提供服务。患有 ADRD 的人可能很难获得高质量的临终关怀，并且参与； APC 的使用减少了临终时接受繁重干预的可能性。这些假设，我们提出了一项使用 2015-2018 年医疗保险索赔和行政管理的横断面研究具有以下具体目的的数据：（1）描述相关的人口和州监管特征 (2) 评估APC护理是否有效与生命最后一个月的急性护理利用、医院死亡、临终关怀利用以及 ADRD 患者的饲管置入；以及 (3) 评估 APC 护理对治疗结束是否有影响各州的生活结果各不相同，其实践法规范围也不同，这将是第一项研究。检查 APC 对 ADRD 患者或任何患有 ADRD 的人群的临终结果的影响这项研究的结果将为疗养院、医生的人员配置提供信息。诊所和其他照顾 ADRD 患者的医疗机构为国家提供指导；设计 APC 实践法规范围的政策制定者；并为劳动力规划、培训和培训提供信息；学校和医疗机构的招聘工作。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Socioeconomic Disparities in Community Mobility Reduction and COVID-19 Growth.

DOI：
10.1016/j.mayocp.2020.10.019
发表时间：
2021-01
期刊：
Mayo Clinic proceedings
影响因子：
8.9
作者：
Ossimetha A;Ossimetha A;Kosar CM;Rahman M
通讯作者：
Rahman M

Advanced practice clinician care and end-of-life outcomes for community- and nursing home-dwelling Medicare beneficiaries with dementia.

为患有痴呆症的社区和疗养院医疗保险受益人提供先进的临床医生护理和临终结果。

DOI：
10.1002/alz.13052
发表时间：
2023
期刊：
Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子：
0
作者：
Oh,Hyesung;White,ElizabethM;Muench,Ulrike;Santostefano,Christopher;Thapa,Bishnu;Kosar,Cyrus;Gadbois,EmilyA;Osakwe,ZainabToteh;Gozalo,Pedro;Rahman,Momotazur
通讯作者：
Rahman,Momotazur

Assessment of Rural-Urban Differences in Health Care Use and Survival Among Medicare Beneficiaries With Alzheimer Disease and Related Dementia.