Surgeon and hospital factors associated with racial and ethnic disparities in surgical outcomes among persons with AD/ADRD

与 AD/ADRD 患者手术结果的种族和民族差异相关的外科医生和医院因素

• 批准号: 10711241
• 负责人: Yusuke Tsugawa
• 金额: $ 36.91万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-12 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10711241
• 关键词: Address; Affect; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease patient; American Hospital Association; American Medical Association; Association of American Medical Colleges; Black race; Caring; Cessation of life; Characteristics; Clinical Trials; Communication; Data; Data Set; Databases; Decision Making; Dementia; Disparity; Educational process of instructing; Ensure; Future; Goals; Health system; Healthcare; Hip Fractures; Hispanic; Hospitals; Impaired cognition; Intervention; Knowledge; Length of Stay; Link; Medical Residency; Medical Students; Medicare claim; Methods; National Institute on Minority Health and Health Disparities; Operative Surgical Procedures; Outcome; Parents; Patient Preferences; Patients; Persons; Pharmaceutical Preparations; Physical Function; Physicians; Play; Population; Postoperative Period; Process; Research; Research Personnel; Residencies; Role; Schools; Services; Surgeon; Surveys; Testing; United States Agency for Healthcare Research and Quality; Vulnerable Populations; accountable care organization; caregiving; cultural competence; dementia care; disparity reduction; ethnic disparity; ethnic diversity; ethnic minority; experience; gender diversity; health care disparity; high risk; hospital readmission; innovation; interdisciplinary approach; medical schools; member; minority communities; minority patient; mortality; operation; patient-clinician communication; programs; provider communication; racial disparity; racial diversity; racial minority; surgery outcome; surgical disparities; Address; Affect; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease patient; American Hospital Association; American Medical Association; Association of American Medical Colleges; Black race; Caring; Cessation of life; Characteristics; Clinical Trials; Communication; Data; Data Set; Databases; Decision Making; Dementia; Disparity; Educational process of instructing; Ensure; Future; Goals; Health system; Healthcare; Hip Fractures; Hispanic; Hospitals; Impaired cognition; Intervention; Knowledge; Length of Stay; Link; Medical Residency; Medical Students; Medicare claim; Methods; National Institute on Minority Health and Health Disparities; Operative Surgical Procedures; Outcome; Parents; Patient Preferences; Patients; Persons; Pharmaceutical Preparations; Physical Function; Physicians; Play; Population; Postoperative Period; Process; Research; Research Personnel; Residencies; Role; Schools; Services; Surgeon; Surveys; Testing; United States Agency for Healthcare Research and Quality; Vulnerable Populations; accountable care organization; caregiving; cultural competence; dementia care; disparity reduction; ethnic disparity; ethnic diversity; ethnic minority; experience; gender diversity; health care disparity; high risk; hospital readmission; innovation; interdisciplinary approach; medical schools; member; minority communities; minority patient; mortality; operation; patient-clinician communication; programs; provider communication; racial disparity; racial diversity; racial minority; surgery outcome; surgical disparities

Abstract This proposed supplement examines the racial and ethnic (R/E) disparities in surgical outcomes and potential contributing factors—such as surgeon and hospital characteristics—among persons with Alzheimer’s disease and its related dementias (AD/ADRD) who undergo surgery. Due to the aging of the population, it has become increasingly common for persons with AD/ADRD to undergo a surgical procedure, with hip fracture being the most frequent indication. Existing studies have shown that patients from R/E minoritized communities undergoing surgery experience higher mortality, complications, and readmissions than White patients. Similarly, R/E disparities in AD/ADRD care, including the use of medications and long-term services, caregiving, and mortality, are well documented. However, little is known regarding R/E disparities in surgical outcomes among persons with AD/ADRD undergoing surgery. To address this knowledge gap, we will leverage the parent NIMHD project that examines surgeon characteristics associated with R/E disparities in surgical outcomes using a comprehensive dataset consisting of Medicare claims data, the Doximity physician database, the Association of American Medical Colleges Medical School database, and the American Medical Association Residency database. In Aim 1, we will determine whether the R/E disparities in surgical outcomes (e.g., length of stay, complications, 30-day, 90-day, and 1-year operative mortality) differ between surgical patients with AD/ADRD compared to those without AD/ADRD. We hypothesize that R/E disparities in surgical outcomes are exacerbated among persons with AD/ADRD because of their vulnerabilities and challenges with communicating with clinicians effectively, which is an important contributor to disparities. In Aim 2, we will identify surgeon characteristics associated with R/E disparities in surgical outcomes among persons with AD/ADRD. We hypothesize that certain characteristics of surgeons (e.g., age, gender, R/E diversity of medical school and residency program, number of R/E minoritized patients treating) are associated with larger or smaller disparities in surgical outcomes among persons with AD/ADRD. In Aim 3, we will identify hospital characteristics associated with R/E disparities in surgical outcomes among persons with AD/ADRD. We hypothesize that certain hospital characteristics (e.g., teaching status, accountable care organization participation, diversity of board members) are associated with disparities in surgical outcomes among persons with AD/ADRD. We will additionally link the American Hospital Association Hospital database, the American Hospital Association National Health Care Governance Survey data, and the AHRQ Compendium of US Health Systems to obtain hospital characteristics. This project will identify potentially modifiable factors associated with disparities in persons with AD/ADRD who undergo surgery and inform future interventions to reduce disparities in this vulnerable population.

抽象的 这项拟议的补充考试是手术结果和潜在的种族和种族分布 促成因素（例如外科医生和医院特征）患有阿尔茨海默氏病的人 及其接受手术的相关痴呆症（AD/ADRD）。 由于人口的衰老，对AD/ADRD的人来说，经历越来越普遍 外科手术，髋部骨折是最常见的迹象。现有研究表明 R/E少数社区接受手术的患者的死亡率，并发症和 复习与白人患者。同样，AD/ADRD护理中的R/E分布，包括使用药物 以及长期服务，护理和死亡率有充分的记录。但是，关于r/e知之甚少 AD/ADRD接受手术的人的手术结局差异。 为了解决这个知识差距，我们将利用考试外科医生的父母NIMHD项目 使用综合数据集组成的综合数据集与手术结果中的R/E差异相关的特征 Medicare索赔数据，Doximity物理数据库，美国医学院协会 医学院数据库和美国医学协会居住数据库。 在AIM 1中，我们将确定手术结果的R/E差异是否（例如，住院时间， AD/ADRD手术患者之间的并发症，30天，90天和1年的操作死亡率） 与没有AD/ADRD的人相比。我们假设手术结果的R/E差异是 由于他们的脆弱性和挑战，在有广告/ADRD的人中加剧了 有效与临床医生进行交流，这是差异的重要原因。 在AIM 2中，我们将确定与R/E差异相关的外科医生特征 有广告/adrd的人。我们假设外科医生的某些特征（例如年龄，性别，r/e 医学院和居住计划的多样性，R/E的少数治疗患者数量） AD/ADRD患者的手术结局差异更大或较小。 在AIM 3中，我们将确定与R/E相关的医院特征 有广告/adrd的人。我们假设某些医院特征（例如，教学状态， 负责任的护理组织的参与，董事会成员的多样性）与分配有关 AD/ADRD患者中的手术结局。我们还将链接美国医院协会 医院数据库，美国医院协会国家医疗保健治理调查数据和 美国卫生系统的AHRQ汇编以获得医院特征。 该项目将确定与AD/ADRD患者的差异相关的潜在可修改因素 接受手术并告知将来的干预措施，以减少该脆弱人群的分布。