The effect of medical school, residency program, and health system board diversities on racial and ethnic disparities in AD/ADRD care.

医学院、住院医师计划和卫生系统董事会多元化对 AD/ADRD 护理中种族和民族差异的影响。

• 批准号: 10727757
• 负责人: Yusuke Tsugawa
• 金额: $ 46.76万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10727757
• 关键词: Acute; Advance Directives; Affect; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; American Hospital Association; American Medical Association; Association of American Medical Colleges; Awareness; Behavior; Caregivers; Caring; Categories; Characteristics; County; Cultural Sensitivity; Data; Data Set; Databases; Dementia; Disparity; Distress; Equity; Ethnic Origin; Health Personnel; Health system; Healthcare; Home; Hospitalization; Hospitals; Institutional Policy; Instruction; Intervention; Knowledge; Leadership; Link; Long-Term Care; Medical; Medical Education; Medical Students; Medicare claim; Methods; Minority; Modeling; Outcome; Patient-Focused Outcomes; Patients; Performance; Pharmaceutical Preparations; Physicians; Policies; Policy Maker; Positioning Attribute; Process; Quality of Care; Quality of life; Quasi-experiment; Race; Research; Research Personnel; Residencies; Rotation; Sampling; Schools; Statistical Methods; Surveys; Testing; Training; Training and Education; care providers; care systems; cultural competence; dementia care; disparity elimination; disparity reduction; econometrics; end of life; ethnic disparity; ethnic diversity; ethnic minority; ethnic minority population; evidence base; experience; health assessment; improved; innovation; instrument; medical schools; minority patient; minority student; nonEnglish language; professional atmosphere; programs; racial disparity; racial diversity; racial minority; racial minority population; safety net; Acute; Advance Directives; Affect; Alzheimer' s Disease; Alzheimer' s disease patient; Alzheimer' s disease related dementia; American Hospital Association; American Medical Association; Association of American Medical Colleges; Awareness; Behavior; Caregivers; Caring; Categories; Characteristics; County; Cultural Sensitivity; Data; Data Set; Databases; Dementia; Disparity; Distress; Equity; Ethnic Origin; Health Personnel; Health system; Healthcare; Home; Hospitalization; Hospitals; Institutional Policy; Instruction; Intervention; Knowledge; Leadership; Link; Long-Term Care; Medical; Medical Education; Medical Students; Medicare claim; Methods; Minority; Modeling; Outcome; Patient-Focused Outcomes; Patients; Performance; Pharmaceutical Preparations; Physicians; Policies; Policy Maker; Positioning Attribute; Process; Quality of Care; Quality of life; Quasi-experiment; Race; Research; Research Personnel; Residencies; Rotation; Sampling; Schools; Statistical Methods; Surveys; Testing; Training; Training and Education; care providers; care systems; cultural competence; dementia care; disparity elimination; disparity reduction; econometrics; end of life; ethnic disparity; ethnic diversity; ethnic minority; ethnic minority population; evidence base; experience; health assessment; improved; innovation; instrument; medical schools; minority patient; minority student; nonEnglish language; professional atmosphere; programs; racial disparity; racial diversity; racial minority; racial minority population; safety net

Project Summary High-quality care throughout the trajectory of illness of Alzheimer's disease and Alzheimer's disease- related dementias (AD/ADRD) has been shown to be associated with a better quality of life, lower caregiver distress, and reduced use of acute and long-term care. However, racial and ethnic (R&E) minoritized persons with AD/ADRD often receive poorer quality care than White patients, including lower rates of advance directives, reduced receipt of anti-dementia medications, and increased end-of-life hospitalizations. Although governmental and institutional policies influence R&E diversity in medical education/training and work environments, little is known about how R&E diversity in medical education, residency training, and health system leadership affect R&E disparities in AD/ADRD care. This knowledge gap has hindered efforts to develop interventions that could effectively eliminate disparities in AD/ADRD care. The proposed study will address these important knowledge gaps by applying the quasi-experimental methods to the comprehensive data on patients, physicians, medical schools, residency programs, and health systems we will develop by linking 7 nationally-representative databases (Medicare Claims Data, Consumer Assessment of Healthcare Providers and Systems Data, Doximity Physician Data, Association of American Medical Colleges Medical School Data, American Medical Association Residency Program Data, RAND Health System Data, and American Hospital Association National Health Care Governance Survey Data). In Aim 1, we will determine the effect of the R&E diversity of medical school student bodies from which physicians graduated on disparities in AD/ADRD care, by applying the quasi-experimental instrumental variable method using the state affirmative action bans as an instrument. The state affirmative action bans serve as an ideal instrument because they are strongly associated with medical school student body diversity, but do not directly affect AD/ADRD care. In Aim 2, we will determine the effect of 4 residency program characteristics (higher R&E diversity of residents, presence of cultural competence awareness program, instruction in medical Spanish or other non-English languages, and rotation at the county and safety-net hospitals) on R&E disparity in AD/ADRD care, using the propensity score matching method. In Aim 3, we will determine the effect of R&E diversity of health system boards on disparities in AD/ADRD care, by applying the propensity score matching method. This project will provide a robust evidence base for policymakers to develop policy interventions (e.g., increasing R&E diversity and introducing the cultural competency awareness program at medical schools, residency programs, and health systems) that could effectively mitigate R&E disparities in AD/ADRD care. The research team consists of investigators with expertise in all relevant fields (Alzheimer's disease and dementia research, R&E disparity research, medical education and training, organizational behaviors, physician and health system performance, and econometric and statistical methods) to conduct this innovative research.

项目摘要 在整个阿尔茨海默氏病和阿尔茨海默氏病的疾病轨迹中，高质量的护理 - 相关痴呆症（AD/ADRD）已被证明与更好的生活质量，较低的照料者有关 痛苦，减少了急性和长期护理的使用。但是，种族和种族（R＆E）少数人 与白人患者相比，AD/ADRD通常会获得质量较差的护理，包括较低的提前率 指令，减少抗痴呆药物的收到以及增加寿命的住院治疗。虽然 政府和机构政策影响医学教育/培训和工作的R＆E多样性 环境，关于医学教育，居住培训和健康的R＆E多样性知之甚少 系统领导会影响AD/ADRD护理中的研发差异。这种知识差距阻碍了努力 制定可以有效消除AD/ADRD护理差异的干预措施。拟议的研究将 通过将准实验方法应用于综合性来解决这些重要的知识差距 我们将开发有关患者，医师，医学院，居住计划和卫生系统的数据 链接7个全国代表性数据库（Medicare索赔数据，消费者评估医疗保健 提供者和系统数据，Doximity医师数据，美国医学院医学协会 学校数据，美国医学协会居住计划数据，兰德健康系统数据和 美国医院协会国家医疗保健治理调查数据）。在AIM 1中，我们将确定 医学院学生团体的R＆E多样性的影响，医生毕业于差异 在AD/ADRD护理中，通过使用状态肯定的应用准实验仪器变量方法 行动禁止作为工具。国家平权行动禁令是理想的工具，因为它们是 与医学院学生的多样性密切相关，但不会直接影响AD/ADRD护理。在 AIM 2，我们将确定4个居住计划特征的影响（居民的R＆E多样性较高， 存在文化能力意识计划，西班牙医学或其他非英语的指导 语言，以及在AD/ADRD护理中的R＆E差异的县和安全网医院的旋转 倾向分数匹配方法。在AIM 3中，我们将确定卫生系统R＆E多样性的影响 通过应用倾向分数匹配方法，在AD/ADRD护理中差异的董事会。这个项目将 为政策制定者提供了强大的证据基础，以制定政策干预措施（例如，提高R＆E多样性 并在医学院，居住计划和 卫生系统）可以有效地减轻AD/ADRD护理中的R＆E差异。研究小组包括 在所有相关领域具有专业知识的研究人员（阿尔茨海默氏病和痴呆研究，R＆E） 研究，医学教育和培训，组织行为，医师和卫生系统表现， 以及计量经济学和统计方法）进行这项创新研究。