The Impact of Alzheimer's Disease and Related Dementias on Older Adults' Medicare Coverage Choices, Financial Well-being, and Health

阿尔茨海默病和相关痴呆症对老年人医疗保险覆盖选择、财务状况和健康的影响

• 批准号: 10673046
• 负责人: Brian McGarry
• 金额: $ 12.68万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10673046
• 关键词: Adverse effects; Affect; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Area; Award; Budgets; Caregiver support; Caregivers; Clinical; Cognitive aging; Cognitive deficits; Complex; Data; Decision Making; Dementia; Diagnosis; Disease; Drug Prescriptions; Elderly; Ensure; Equity; Family Caregiver; Foundations; Future; Health; Health Services; Health Services Accessibility; Health Services Needs; Health Services Research; Health Services for the Aged; Health Status; Health and Retirement Study; Household; Impaired cognition; Impairment; Individual; Institution; Interdisciplinary Study; Intervention; Interview; K-Series Research Career Programs; Lead; Leadership; Link; Measurement; Medicare; Medicare Part C; Medicare claim; Medicine; Mentors; Mentorship; Methods; Outcome; Personal Satisfaction; Policies; Policy Maker; Population; Predisposition; Privatization; Psychologist; Qualitative Research; Quasi-experiment; Research; Research Methodology; Research Personnel; Resources; Risk; Role; Security; Surveys; Testing; Time; Training; Universities; Vulnerable Populations; beneficiary; career development; clinical care; cognitive ability; cognitive capacity; cognitive change; cognitive disability; coping; cost; decision-making capacity; design; experience; family caregiving; health care availability; health inequalities; mild cognitive impairment; multidisciplinary; poor health outcome; professor; programs; response; social; socioeconomics

1. PROJECT SUMMARY/ABSTRACT This NIA career development award will establish Dr. McGarry, an Assistant Professor in the Department of Medicine at the University of Rochester (UR), as an independent investigator with expertise in the areas of cognitive aging, including Alzheimer’s Disease and related dementias (ADRD), and consumer choice in the Medicare program. With support from the award, Dr. McGarry will undertake a training plan that focuses on: 1) the clinical trajectory of ADRD, 2) ADRD family caregiving and research, 3) qualitative research methods, and 4) leadership of a multidisciplinary research team. This training will enable Dr. McGarry to conduct multidisciplinary, mixed-methods research examining the impact of ADRD on Medicare choices and resultant outcomes. It builds off his current areas of expertise, including Medicare policy and benefit design and quantitative health services research. Dr. McGarry has leveraged the considerable resources available at UR to assemble a multidisciplinary team of nationally-recognized experts. Dr. Kathi Heffner, the primary career development mentor, is a social psychologist with expertise in cognitive aging and the study of caregivers with ADRD. Dr. Helena Temkin-Greener, the primary methods mentor, is a health services researcher with expertise in the delivery and quality of health services for older adults and mixed methods research. Together they will lead a mentorship team with additional expertise in qualitative research methods, the measurement of functional cognitive abilities, the diagnosis and clinical care of individuals with ADRD, and the use of national survey data linked with Medicare claims to study health outcomes in older adults. The Medicare program depends on consumer choice, yet little is known about the ability of older adults with ADRD to navigate this complexity. Available evidence suggests this population is at increased risk of suboptimal coverage choices, yet little is known about how these risks evolve over the disease course and their health and financial effects. This mixed-methods study will examine the Medicare coverage choices of individuals with ADRD throughout the disease course (Aim 1). The Health and Retirement Study (HRS) linked with Medicare claims will be used to describe the Medicare coverage, and propensity to make changes, of individuals with ADRD at various stages of cognitive decline. Analyses will also examine whether the impacts of cognitive declines are moderated by the availability of family caregivers and socioeconomic resources. Qualitative interviews with caregivers of individuals with ADRD will add depth and support the interpretation of the quantitative results. Using the same HRS data, the effects of impaired household Medicare decision making due to ADRD on health and financial outcomes will be estimated using a quasi-experimental design (Aim 2). Study results will provide critical information to policy makers about the effects of Medicare program design on the well-being of individuals with ADRD. In combination with mentored training, this research will form the basis of an R01 proposal that will evaluate the effects of potential policy reforms designed to support Medicare choices in households with ADRD and the acceptability of such reforms to this population.

1. 项目概要/摘要 该 NIA 职业发展奖将授予 McGarry 博士，他是该系的助理教授 罗切斯特大学 (UR) 医学博士，作为一名独立研究者，在认知领域拥有专业知识 老龄化，包括阿尔茨海默病和相关痴呆症 (ADRD)，以及消费者对医疗保险计划的选择。 在该奖项的支持下，McGarry 博士将开展一项培训计划，重点关注：1) 的临床轨迹 ADRD，2) ADRD 家庭护理和研究，3) 定性研究方法，以及 4) 领导力 该培训将使麦加里博士能够进行多学科、混合方法的研究。 这项研究考察了 ADRD 对医疗保险选择及其结果的影响，该研究建立在他当前的研究领域之上。 McGarry 博士拥有丰富的专业知识，包括医疗保险政策和福利设计以及定量健康服务研究。 利用 UR 的大量资源组建了一支由国家认可的多学科团队 首席职业发展导师 Kathi Heffner 博士是一位具有认知专业知识的社会心理学家。 主要方法导师 Helena Temkin-Greener 博士是一项健康研究。 服务研究人员，在老年人保健服务的提供和质量和混合方法方面拥有专业知识 他们将共同领导一个在定性研究方法、 功能性认知能力的测量、ADRD 患者的诊断和临床护理以及使用 与医疗保险声称相关的全国调查数据，用于研究老年人的健康结果。 医疗保险计划取决于消费者的选择，但人们对老年人的能力知之甚少 ADRD 应对这种复杂性的现有证据表明，该人群面临的次优风险增加。 承保选择，但人们对这些风险在疾病过程中如何演变以及他们的健康状况和健康状况知之甚少。 这项混合方法研究将考察 ADRD 患者的医疗保险覆盖选择。 与医疗保险索赔相关的健康和退休研究 (HRS) 将在整个疾病过程中进行（目标 1）。 用于描述 ADRD 患者在不同阶段的医疗保险覆盖范围以及做出改变的倾向 分析还将检验认知能力下降的影响是否受到影响。 家庭照顾者的可用性和社会经济资源。对患有此类疾病的个人的照顾者进行定性访谈。 ADRD 将增加深度并支持使用相同的 HRS 数据和效果的解释。 将估计因 ADRD 导致的家庭医疗保险决策受损对健康和财务结果的影响 使用准实验设计（目标 2），研究结果将为政策制定者提供有关该问题的关键信息。 医疗保险计划设计对 ADRD 患者福祉的影响 结合指导培训， 这项研究将构成 R01 提案的基础，该提案将评估潜在政策改革的效果，旨在 支持 ADRD 家庭的医疗保险选择以及此类改革对该人群的可接受性。