Care for Persons With Dementia in Nurse Practitioner Practices and Racial and Ethnic Health Disparities

护士执业实践中对痴呆症患者的护理以及种族和民族健康差异

基本信息

批准号：
10448513
负责人：
Lusine Poghosyan
金额：
$ 77.09万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10448513
关键词：
Accident and Emergency department Address Administrator Affect Alzheimer&apos s disease related dementia American Black Populations Care given by nurses Caring Chronic Disease Clinical Cognitive Communities Competence Continuity of Patient Care Data Data Analyses Dementia Disease Disease Management Elderly Emergency department visit Ensure Environment Ethnic group Face Failure Family Future Geographic Information Systems Hispanic Populations Hospitalization Individual Intervention Interview Investments Link Measures Mediating Mediation Medicare Methods Minority Minority Groups Modeling Nurse Practitioners Outcome Patient Care Patient-Focused Outcomes Patients Persons Policies Prevalence Primary Care Physician Primary Health Care Provider Qualitative Methods Quality of Care Race Reminder Systems Research Priority Resources Risk Factors Role Socioeconomic Factors Survey Methodology Surveys System Telephone Time Training Visit acute care beneficiary care delivery care systems community barrier community intervention community-level factor cost dementia care design deviant disparity reduction ethnic health disparity ethnic minority follow-up health care settings health disparity health disparity populations hospitalization rates improved innovation minority communities multilevel analysis poor communities practice factors primary outcome public health intervention racial and ethnic racial and ethnic disparities racial minority response therapy design underserved area

项目摘要

More than 5.7 million Americans are living with Alzheimer's disease and related dementias (AD/ADRD); this number is expected to double by 2030 and triple by 2050. Racial and ethnic minorities disproportionality suffer. Minority Persons With Dementia (PWD), particularly community-dwelling, lack high quality continuous primary care and have poor outcomes such as high rates of hospitalizations and emergency department (ED) use. Policymakers caution that health disparities will widen as we face a shortage of primary care physicians. Nurse practitioners (NPs), the fastest growing primary care workforce, could mitigate these challenges. NPs disproportionality deliver care to minorities and practice in underserved areas where many minorities live. Yet little is known about how to optimize primary care practices employing NPs, which often lack the organizational and structural attributes needed to ensure continuity of care and better outcomes for minority PWD. Little is also known about how to enhance community resources to eliminate health disparities for PWD. Our mixed- method national study will fill this gap. We will achieve three specific aims: Aim 1. Assess the effect of NP practice attributes (i.e., care environment and structural capabilities) on racial and ethnic disparities in ED visits and hospitalizations among PWD and the extent to which the effect is mediated by continuity of care. Aim 2. Assess the effect of community socioeconomic factors and primary care availability on disparities in ED visits and hospitalizations among PWD. Aim 3. Identify practice and community barriers and facilitators of caring for PWD in high- and low-performing NP practices. We will use data on community-dwelling Medicare beneficiary PWD cared for by NPs in 2017-2018 and will collect survey data from NPs (n= 4,414) about care environments and structural capabilities using both mail and online survey methods. All data about patients, NPs, practices, and communities will be merged and analyzed in multilevel models. We will also identify practices with low rates of hospitalizations and ED visits (i.e., high-performing practices) and high rates for hospitalizations and ED visits (i.e., low-performing practices) among PWD and collect qualitative interview data from NPs using a positive deviance approach. We will conduct individual telephone or online interviews with ~40 NPs from high- performing and ~20 NPs from low-performing practices. Interviews will be recorded and transcribed. Data will undergo content analysis. Quantitative and qualitative findings will be triangulated to inform administrators and policymakers seeking ways to reduce racial and ethnic disparities in acute care use among PWD through practice, policy, and community interventions. We will identify modifiable factors of high-performing practices that could be introduced in low-performing practices to enhance care to PWD and practices and communities that can most benefit from such interventions and future investments. This innovative study has the potential to make clinical and policy contributions by promoting continuous primary care to millions of minority community- dwelling PWD and is in response to High-Priority Research Topic NOT-AG-18-056 and NOT-MD-19-016.

超过570万美国人患有阿尔茨海默氏病和相关痴呆症（AD/ADRD）；这预计到2030年的人数预计将翻一番，到2050年将三倍。种族和少数民族不成比例。痴呆症（PWD），尤其是社区居住的少数民族，缺乏高质量连续的初级护理和较差的结果，例如住院和急诊科（ED）的使用率很高。决策者警告说，随着我们面临初级保健医生的短缺，健康差异将扩大。护士从业者（NP）是增长最快的初级保健员工队伍，可以缓解这些挑战。 NPS 在许多少数族裔居住的地区，为少数群体提供护理和执业。然而关于如何优化使用NP的初级保健实践的知识知之甚少，NP通常缺乏组织以及确保少数民族PWD的护理连续性和更好结果所需的结构属性。几乎没有也知道如何增强社区资源以消除PWD的健康差异。我们的混合方法国家研究将填补这一空白。我们将实现三个具体目标：目标1。评估NP的影响练习属性（即护理环境和结构能力）在埃德访问中的种族和种族差异 PWD之间的住院以及其效果是由护理连续性介导的。目标2。评估社区社会经济因素和初级保健的影响对ED访问差异的影响和PWD中的住院。目标3。确定练习和社区障碍和关怀的促进者高性能和低表现的NP实践中的PWD。我们将使用有关社区居民医疗保险受益人的数据 PWD在2017 - 2018年受到NP的照顾，并将从NP（n = 4,414）收集有关护理环境的调查数据以及使用邮件和在线调查方法的结构功能。有关患者，NP，实践的所有数据，社区将在多层次模型中合并和分析。我们还将确定低点的做法住院和急诊就诊（即高性能做法）和住院和高率 ED访问（即低表现的做法）在PWD中，并使用A收集NPS的定性访谈数据积极的偏差方法。我们将对高高的约40个NP进行单独的电话或在线访谈从低表现的实践中执行约20个NP。访谈将被记录和转录。数据将进行内容分析。定量和定性的发现将进行三角剖分，以告知管理员和政策制定者正在寻求减少PWD急性护理中种族和种族差异的方法实践，政策和社区干预措施。我们将确定高性能实践的可修改因素这可以在低绩效的实践中引入，以增强对PWD的护理以及实践和社区这可以从此类干预措施和未来的投资中受益最大。这项创新的研究有可能通过促进数百万少数民族社区的持续初级保健来做出临床和政策贡献 - 居住的PWD，是针对高优先研究主题而不是AG-18-056，而不是MD-19-016。