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.

项目概要/摘要 在当前的护理模式下，患有帕金森病 (PD) 或帕金森病痴呆症的人 (PDD)，接受过度、低价值的护理，PD 和 PDD 中的“非运动”症状未被充分认识和认识。 治疗不足，是住院和住院治疗的潜在促成因素。 针对非运动症状的不当药物使用在 PD 和 PDD 中很常见。 罕见（<5%），临终时的 ICU 护理和院内死亡很常见（>20%）。 需求，属于姑息治疗领域的护理计划、症状管理、安全处方、 临终关怀将对人口健康产生重大影响。 早期研究表明，PD 患者和 PDD 患者接受的护理也不平等。 个体因素——女性、西班牙裔、亚洲人和黑人种族——与较低的可能性相关 反过来，目前减少差异的策略侧重于个人。 行为（如寻求帮助），尽管差异也是由提供者运作的因素驱动的， 扩大 PD/PDD 差异研究的范围，将以下方面的研究纳入其中： 医疗保健组织结构和医疗服务提供流程可以确定新的机制途径 并为实现公平结果开辟新途径。 针对疾病的姑息治疗 (PC) 已被证明可以改善结果并减少低价值护理 最近，PD 定制的、基于团队的、以神经病学为主导的 PC 已在多种神经系统疾病中得到应用。 经证明可以改善患者的生活质量、非运动症状管理和护理人员的结果。 基于这些结果，一个大规模的实施项目将使集成 PC 成为新的护理标准 大约一半的美国学术运动障碍中心正在进行中，我们建议利用该项目。 项目实施创建的自然实验，以确定神经病学团队主导的 PC 对 卫生服务成果，并提供卫生保健改变程度的证据 组织结构和交付流程影响医疗保健和结果差异 少数民族、女性、农村和社会经济弱势群体 PD 和 PDD 人群。 该应用程序的目的是 (1) 检查 PC 领域的医疗保健使用情况以及 PC 差异 患有 PD 和 PDD 的 Medicare 受益人，以及 (2) 测试 PC 干预对 PC 领域健康的影响 我们提议的工作将产生有关护理利用结果和结果差异的基准国家数据。 PD、PDD 结果阐明了 PD 和 PDD 差异的中心级别差异。 PD/PDD 特定的神经姑息治疗标准将通过影响神经病学研究和护理。 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 了解神经病学中心学术差异的驱动因素。