Impact of federal policies on disparities at the end of life care among nursing home residents with Alzheimer's diseases or related dementia

联邦政策对患有阿尔茨海默病或相关痴呆症的疗养院居民临终关怀差异的影响

• 批准号: 10729733
• 负责人: Lichuan Ye
• 金额: $ 58.63万
• 依托单位: NORTHEASTERN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-15 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729733
• 关键词: Advocacy; Affect; Alzheimer' s disease patient; Alzheimer' s disease related dementia; American; Assessment tool; Black race; Caring; Categories; Cessation of life; Characteristics; Classification; Clinical; Communities; Complex; Data; Data Set; Data Sources; Dementia; Disparity; Elderly; Emergency department visit; Enteral Feeding; Equity; Goals; Health; Hospice Care; Hospice Programs; Hospitalization; IV Fluid; Individual; Insurance Carriers; Intensive Care Units; Interruption; Intervention; Length; Life; Location; Machine Learning; Measures; Medicare; Methods; Nursing Homes; Pathway Analysis; Patient Care; Patient Selection; Patients; Pharmaceutical Preparations; Phenotype; Police; Policies; Policy Maker; Prognosis; Provider; Quality of life; Race; Reporting; Risk; Series; Subgroup; Syndrome; Time; Vulnerable Populations; acute care; beneficiary; care providers; curative treatments; end of life; end of life care; experience; federal policy; health equity; health equity promotion; high risk; high risk population; hospice environment; improved; insight; multiple chronic conditions; pain reduction; racial disparity

Project Summary Racial disparities in end-of-life (EOL) care continue to persist in nursing home (NH) residents with Alzheimer’s disease and related dementia (ADRD). Recent studies reported that black NH residents with dementia were more likely to receive aggressive EOL care, including hospitalizations, ER visits, feeding tubes and aggressive medication therapy, compared to Whites. ADRD is a progressive, life-limiting syndrome without a curative treatment. Hence, hospice care is preferable for older adults with ADRD during EOL because it prioritizes comfort and quality of life by reducing pain and suffering. Medicare is the primary insurer of patients with ADRD and covers hospice for all with a 6-months or shorter prognosis. As about 90% of older Americans with ADRD are placed in NHs before death, it is critically important for Medicare policy makers to understand contemporary characteristics of racial disparities in hospice care in NHs in order to implement efficient policies to promote health equity. Recently, there raised concerns about fraudulent/inappropriate patient selection practices that favored long-stay patients, particularly ADRD patients, because patients with longer hospice stays generated greater profits for hospices. To discourage hospice selection for long-stay patients, Medicare launched the 2014 Improving Medicare Post-Acute Care Transformation (IMPACT) Act to mandate auditing targeted hospices with high proportion of patient staying longer than 180 days. It remains unaddressed how racial disparities change with implementing IMPACT in NH residents with ADRD. The project’s overall goal is to improve EOL health equity for NH residents with ADRD. The aims for this R01 proposal are to identify the effects of IMPACT on racial disparities in hospice care in NH residents with ADRD, and to characterize subgroups that are most likely to experience inadequate hospice care. The primary hypothesis is that racial disparities in EOL care increased persistently after IMPACT was implemented. We will employ mixed methods to accomplish the following aims (A) and hypotheses (H): A1. To examine impacts of IMPACT on racial disparities in hospice care in NH residents with ADRD. A2. To characterize phenotypes of NH residents with ADRD based on multimorbidity who have high risks for very short or very long hospice care, and compare these phenotypes between Black and White residents. A3. To obtain perspectives of care providers in NHs about how hospice polices may influence hospice care referrals among residents with ADRD. An expert panel of clinical advisors will identify barriers to hospice care referrals, and potential mechanisms through which Medicare policies could reduce them. This study will evaluate Medicare policy on racial disparities in hospice care among a very vulnerable population: older adults with ADRD who reside in NHs. Results will also identify subgroups of these individuals at high risk of inadequate hospice stays. Findings will support clinicians with insight about how interventions to reduce racial disparities and improve health equity can be targeted to individuals in high-risk groups.

项目摘要 在养老院（NH）居民的种族分布（EOL）护理中的种族分布继续存在于阿尔茨海默氏症 疾病和相关痴呆症（ADRD）。最近的研究报告说，黑人NH痴呆症患者是 更有可能获得积极的EOL护理，包括住院，急诊室，喂养管和侵略性 与白人相比，药物疗法。 ADRD是一种没有治愈性的进步，生命的综合症 治疗。因此，EOL期间患有ADRD的老年人优先考虑临终关怀，因为它优先 减轻痛苦和痛苦，舒适和质量。 Medicare是患者的主要抑制剂 Adrd并为所有人提供了6个月或较短的预后。大约有90％的美国人 ADRD被放置在死亡前的NHS中，对于医疗保险政策制定者来说至关重要 NHS临终关怀护理中种族差异的当代特征，以实施有效的政策 促进健康公平。最近，人们对欺诈性/不适当的患者选择引起了担忧 有利于长期患者，尤其是ADRD患者的实践，因为医院较长的患者 停留为医院带来了更多的利润。为了劝阻长期患者的临终关怀，Medicare 启动了2014年改进的Medicare急性护理转型（Impact）法案，以要求审计 有针对性的医院，患者比例高180天。它仍然没有解决 ADRD的NH居民的影响随着种族差异的变化。 该项目的总体目标是改善ADRD的NH居民的EOL健康权益。 R01的目的 提案是确定对NH居民的临终关怀护理中种族差异的影响的影响， 并描述最有可能体验临终关怀不足的亚组。主要 假设是，在实施影响后，EOL护理中的种族差异持续增加。我们将 员工混合方法来实现以下目标（a）和假设（h）： A1。检查ADRD的NH居民对临终关怀护理中种族差异的影响的影响。 A2。表征基于多种多样的ADRD的NH居民的表型，这些人具有高风险 非常短或非常长的临终关怀护理，并比较黑人和白人居民之间的这些表型。 A3。为了获得NHS中有关临终关怀政策如何影响临终关怀的护理提供者的观点 ADRD居民的照顾转介。临床顾问专家小组将确定 临终关怀的推荐以及医疗保险政策可以减少它们的潜在机制。 这项研究将评估医疗保险政策关于非常脆弱的临终关怀的种族分配 人口：居住在NHS的ADRD的老年人。结果还将确定这些人的子组 临终关怀不足的高风险。调查结果将为临床医生提供有关干预措施的见解 减少种族差异并提高健康公平的目标可以针对高风险群体中的个人。