Leveraging a Natural Experiment to Determine the Effects of Integrated Palliative Care on Health Service Outcomes and Disparities in Parkinson Disease and Lewy Body Dementia

利用自然实验确定综合姑息治疗对帕金森病和路易体痴呆的卫生服务结果和差异的影响

• 批准号: 10701322
• 负责人: Allison Willis
• 金额: $ 230.75万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-21 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10701322
• 关键词: Address; Advance Care Planning; Asian; Awareness; Behavior; Benchmarking; Black race; Caregivers; Caring; Cessation of life; Clinical Research; Cognitive; Data; Dementia; Development; Disease; Disparity; Equity; Ethnic Origin; Evaluation; Female; Funding; Goals; Guidelines; Health; Health Policy; Health Services; Health system; Healthcare; Hispanic; Hospitalization; Hospitals; Huntington Disease; Individual; Inequality; Institutionalization; Intervention; Lewy Body Dementia; Medicare; Minority; Mission; Modeling; Movement Disorders; National Institute of Neurological Disorders and Stroke; Natural experiment; Neighborhoods; Neuroepidemiology; Neurology; Outcome; Palliative Care; Palliative Medicine; Parkinson Disease; Parkinson' s Dementia; Pathway interactions; Patient-Focused Outcomes; Patients; Persons; Pharmaceutical Preparations; Population; Process; Provider; Public Health; Quality of life; Race; Research; Research Institute; Research Personnel; Risk Factors; Rural; Symptoms; Testing; Variant; Work; acute care; beneficiary; care delivery; care outcomes; dementia care; deprivation; disparity reduction; end of life; end of life care; experience; health care service organization; health care service utilization; health disparity; health equity; health inequalities; health organization; health outcome disparity; health service use; help-seeking behavior; implementation research; improved; improved outcome; innovation; member; nervous system disorder; non-motor symptom; organizational structure; outcome disparities; population health; program dissemination; rural residence; sex; sociodemographic disparity; sociodemographics; socioeconomic disadvantage; standard of care; symptom management; symptomatic improvement; translational impact

PROJECT SUMMARY/ABSTRACT Under current care models, persons living with Parkinson Disease (PD) or Parkinson Disease Dementia (PDD), receive excessive, low-value care. “Non-motor” symptoms in PD and PDD are underrecognized and undertreated and are the leading precipitants of hospitalization and institutionalization. Potentially inappropriate medication use for non-motor symptoms is widespread in PD and PDD. Advanced care planning is rare (<5%), ICU care at the end of life and in-hospital deaths are common (>20%). Addressing these unmet needs, which fall under the palliative care domains of care planning, symptom management, safe prescribing, and end of life care would have major population health impacts. Persons living with PD and with PDD also receive unequal care. Early work has shown that static individual factors-female sex, Hispanic ethnicity, and Asian and Black race- associate with a lower likelihood of receiving guideline PD and PDD care. In turn, current strategies to reduce disparities focus on individual behaviors (like help-seeking), even though disparities are also driven by factors operating at the provider, health system and policy levels. Broadening the scope of PD/PDD disparities research to include the study of health care organizational structure and care delivery processes could identify new mechanistic pathways for such disparities, and open new avenues for achieving equitable outcomes. Disease-tailored palliative care (PC) has been shown to improve outcomes and reduces low-value care in multiple neurological diseases. Recently, PD-tailored, team-based, neurology-led PC has been demonstrated to improve patient quality of life, non-motor symptom management and caregiver outcomes. Based on these results, a large-scale implementation project to make integrated PC the new care standard in approximately half of U.S. academic Movement Disorders Centers is underway. We propose to leverage the natural experiment created by the implementation project to determine the effects of neurology team led PC on health service outcomes, and to provide evidence on the degree to which alterations of health care organizational structure and delivery processes impact health care and outcome disparities experienced by minority,female, rural, and socioeconomically disadvantaged PD and PDD populations. The aims of this application are (1) to examine PC domain health care use and PC disparities among Medicare beneficiaries with PD and PDD, and (2) to test the effects of a PC Intervention on PC domain health care utilization outcomes and outcome disparities. Our proposed work will produce benchmark national data on PD, PDD outcomes, illuminate center-level variations in PD and PDD disparities. We also expect to inform PD/PDD-specific neuropalliative care standards. Our results will impact neurology research and care through our innovative approach of evaluating an ongoing dissemination project through public health and health equity lenses to understand the drivers of academic neurology center disparities.

项目摘要/摘要 在当前的护理模型下，患有帕金森病（PD）或帕金森病痴呆症患者 （PDD），获得过多的低价值护理。 PD和PDD中的“非运动器”符号未被认可，并且 被遗忘了，是住院和制度化的主要造成沉淀因子。可能 在PD和PDD中，用于非运动症状的不适当药物使用是广泛的。高级护理计划 很少见（<5％），生命即将结束时的ICU护理很常见（> 20％）。解决这些尚未满足的问题 需求，这些需求属于护理计划，符号管理，安全处方的姑息治疗领域， 生命的尽头将对人口健康产生重大影响。 居住在PD和PDD的人也获得不平等的护理。早期工作表明静态 个人因素 - 女性性别，西班牙裔种族以及亚洲和黑人种族建立的可能性较低 接受指南PD和PDD护理。反过来，当前减少分布的策略集中于个人 即使差距也受到提供商的因素的驱动，行为（例如寻求帮助）， 卫生系统和政策水平。扩大PD/PDD差异研究的范围，包括 医疗保健组织的结构和护理交付过程可以确定新的机械途径 这种差异和开放新的途径，以实现公平的成果。 疾病量身定制的姑息治疗（PC）已显示可改善预后并减少低价值护理 在多种神经系统疾病中。最近，PD泰式，基于团队的神经病学领导的PC一直是 证明是为了提高患者的生活质量，非运动症状管理和护理人员的结果。 基于这些结果，一个大规模实施项目，以使集成PC成为新的护理标准 美国大约一半的学术运动障碍中心正在进行中。我们建议利用 实施项目创建的自然实验是为了确定神经病学团队的效果LED PC 卫生服务成果，并提供有关医疗保健改变的程度的证据 组织结构和交付流程会影响医疗保健和结果分布 少数群体，女性，农村和社会经济处于不利地位的PD和PDD人群。 该应用的目的是（1）检查PC域医疗保健使用和PC差异 具有PD和PDD的Medicare受益人，以及（2）测试PC干预对PC域健康的影响 护理利用结果和结果分布。我们提出的工作将产生基准的国家数据 PD，PDD结果，PD和PDD差异的中心级变化。我们也希望通知 PD/PDD特异性神经化护理标准。我们的结果将通过 我们通过公共卫生和健康公平评估正在进行的传播项目的创新方法 了解学术神经病学中心分布的驱动因素。