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.

抽象的一年多来，COVID-19 大流行给卫生系统、护理人员和患者带来了压力。数千人死亡，数百万人受到感染威胁和缓解努力的影响为了应对这些挑战，医疗保险计划推出了紧急政策。在提供门诊和住院护理方面允许更大的灵活性，包括放宽管理规则不幸的是，远程提供门诊服务和增加医院容量是有限的。有关这些临时政策所带来的护理服务变化如何影响的信息在该项目中，病毒传播和缓解政策时好时坏时的患者结果。我们将研究门诊和住院护理的变化对临床事件发生率和死亡率的影响患有阿尔茨海默病和阿尔茨海默病相关痴呆 (AD/ADRD) 的老年患者这些患者在社区中特别容易受到社会孤立或护理中断，并且那些还有其他缺点（例如虚弱或体质较差）的人可能无法清楚地表达自己的需求。收入似乎更容易受到 COVID-19 感染的不利影响。然而，交付方式的改变可能会增加临床医生与患者互动的数量或质量，例如，由于旅行需求减少，远程医疗就诊更加频繁。因此，要检查其影响。为了改变紧急医疗保险政策下的护理服务，我们将实现三个目标：1) 评估和根据大流行期间收集的数据完善研究变量的定义；门诊护理对临床事件发生率的变化，例如急诊科和住院率；以及 3) 检查患者护理变化对死亡率的影响尤其是就诊和转诊的变化。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 定义使用大流行时代时，大流行前时代出现的状况、虚弱或谵妄可能不太准确我们将检查这些护理模式，评估基于索赔的措施的准确性，并开发数据。我们还将考虑使用机器学习方法和链接、重叠数据集的预测模型；所有目标中县级记录的 COVID-19 感染和就业情况的时间变化。鉴于这些复杂的数据和分析问题，我们将与 NIH 的社会、行为和经济部门合作研究COVID-19联盟以改进此类工作的数据资源和方法。来自这一大型自然实验的信息对于为未来的疫情爆发或其他冲击做好准备至关重要卫生系统，以确定应延长哪些紧急政策（如果有），并通知关于医疗保险范围内地方灵活性和国家标准之间的平衡的争论。