The impact of hospital-based health information technology on health care quality and equity among patients with ADRD

基于医院的卫生信息技术对 ADRD 患者医疗保健质量和公平性的影响

• 批准号: 10729695
• 负责人: Jie Chen
• 金额: $ 193.36万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729695
• 关键词: Adult; Aging; Alzheimer' s disease care; Alzheimer' s disease patient; Alzheimer' s disease related dementia; Ambulatory Care; COVID-19; COVID-19 pandemic; Caregivers; Caring; Communities; Complex; Contracts; Cost Savings; Dementia; Diagnosis; Discrimination; Econometric Models; Emergency Situation; Emergency department visit; Equity; Expenditure; Family member; Health; Health Expenditures; Healthcare; Healthcare Systems; Home; Hospitalization; Hospitals; Individual; Infrastructure; Investments; Mission; Modeling; Outcome; Outpatients; Patients; Persons; Policy Maker; Population; Provider; Public Health; Quality of Care; Reduce health disparities; Research; Resources; Role; Services; Social Work; Structural Racism; Systems Integration; Time; Underserved Population; Visit; Vulnerable Populations; Work; aging population; care coordination; combat; community engagement; cost; cost estimate; data integration; design; digital technology; electronic data; ethnic disparity; ethnic health disparity; ethnic minority; ethnic minority population; evidence base; health care quality; health equity; health information technology; high risk; hospital readmission; hospitalization rates; improved; longitudinal dataset; minority patient; nursing home length of stay; nursing skill; pandemic disease; patient engagement; payment; post-COVID-19; racial disparity; racial minority; racial minority population; social health determinants; telehealth; treatment services

Alzheimer's disease and related dementia (ADRD) is considered one of the most expensive health conditions. Patients with ADRD have more emergency department visits, hospitalizations, ambulatory care sensitivity hospitalization, readmissions, skilled nursing home stays, and home health visits compared to adults without an ADRD diagnosis. Racial and ethnic minorities with ADRD are at high risk for uncoordinated and low-quality care, including higher rates of hospitalizations, preventable hospitalization, avoidable emergency department visits, and health care expenditures. Hospital-based health information technology (hereinafter “hospital-HIT”) is increasingly being used to support care coordination, advance patient engagement, and improve health information exchange. Our team has developed a conceptual framework that delineates the critical roles of hospital-HIT and its application in the care of ADRD patients. Our preliminary findings further show evidence that HIT-supported care can work effectively in ADRD populations. It is critical to implement more robust analyses and comprehensive assessments of the impact of hospital-HIT on health care quality and equity to inform policymakers in the design and implementation of HIT, across the changing needs of ADRD patients (and their caregivers) as dementia progresses. In addition, the COVID-19 pandemic has disproportionately impacted patients with ADRD, especially racial and ethnic minorities. However, the impact of hospital-HIT on health outcomes and equity for persons with ADRD during the pandemic is still lacking. Hence, through the use of ten-year longitudinal dataset before, during, and post the COVID-19 pandemic, and by applying cutting-edge econometric models, this study aims to systematically assess the impact of hospital-HIT on health care quality and equity of patients with ADRD, including the health outcomes during the pandemic. We hypothesize that hospital-HIT that aims to promote care coordination, patient engagement, and data integration can improve health care quality and reduce health care expenditure; and that these impacts will be more pronounced for racial and ethnic minority patients who face substantial barriers to accessing high-quality care. Specifically, we propose to evaluate the impact of hospital-HIT on health care quality (i.e., reduce readmission, preventable ED visits, and preventable hospitalizations) (Aim 1), estimate the extent to which hospital-HIT has reduced racial and ethnic disparities of health care quality and expenditures for the aging population with ADRD (Aim 2); and estimate the extent to which hospital-HIT has impacted health outcomes and quality during the pandemic (Aim 3). Grounded in the HIT-Structural Racism and Discrimination framework for ADRD patients, we expect our results to quantify the impact of hospital-HIT on health care quality for patients with ADRD, including those from racial and ethnic minority groups and communities with different social determinants of health. Results on the impact of hospital-HIT during the pandemic will improve the understanding of how to use hospital-HIT to coordinate care for people with ADRD during the pandemic.

阿尔茨海默氏病和相关痴呆症（ADRD）被认为是最昂贵的健康状况之一。 ADRD患者有更多的急诊就诊，住院治疗，卧床护理敏感性 与没有的成年人相比 ADRD诊断。具有ADRD的种族和少数民族的不协调和低质量有高风险 护理，包括更高的住院率，可预防的住院，可避免的急诊室 访问和医疗保健支出。基于医院的健康信息技术（以下“医院受到破坏”） 越来越多地用于支持护理协调，提高患者参与并改善健康状况 信息交换。我们的团队开发了一个概念框架，描述了 医院袭击及其在ADRD患者护理中的应用。我们的初步发现进一步显示了证据 该受欢迎的护理可以在ADRD人群中有效地工作。实施更健壮至关重要 分析和全面评估医院对医院对医疗保健质量和公平的影响 在ADRD患者的不断变化的需求中，将命中的设计和实施告知政策制定者 （及其护理人员）随着痴呆症的进展。此外，COVID-19大流行的比例不成比例 影响了ADRD的患者，尤其是种族和少数民族。但是，医院受到的影响对 在大流行期间，ADRD患者的健康成果和公平仍然缺乏。因此，通过使用 十年纵向数据集之前，期间和发布COVID-19的大流行，并通过应用尖端 计量经济学模型，本研究旨在系统地评估受损对医疗保健质量的影响 ADRD患者的平等，包括大流行期间的健康结果。我们假设这一点 旨在促进护理协调，患者参与和数据整合的医院袭击可以改善 医疗保健质量并减少医疗保健支出；这些影响会更明显 种族和族裔少数民族患者，他们面临着获得高质量护理的实质性障碍。具体来说，我们 提案以评估受损对医疗保健质量的影响（即减少再入院，可预防 就诊和可预防的住院）（AIM 1）估计了医院遭受损失的程度 与ADRD老龄化人口的医疗保健质量和支出的种族差异（AIM 2）；和 估计医院受到影响在大流行期间影响健康成果和质量的程度（AIM 3）。基于ADRD患者的命中结构种族主义和歧视框架，我们希望我们的 量化医院对ADRD患者的医院对医疗保健质量的影响的结果，包括 来自具有不同健康社会决定者的种族和族裔少数群体和社区。结果 大流行期间受到医院袭击的影响将提高人们对如何使用医院袭击的理解 在大流行期间，协调ADRD患者的护理。