Annual wellness visit policy: Impact on disparities in early dementia diagnosis and quality of healthcare for Medicare beneficiaries with Alzheimer's Disease and Its Related Dementias

年度健康就诊政策：对患有阿尔茨海默病及其相关痴呆症的医疗保险受益人的早期痴呆诊断和医疗质量差异的影响

• 批准号: 10729272
• 负责人: Yong-Fang Kuo
• 金额: $ 40.99万
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729272
• 关键词: Address; Adopted; Adoption; Advance Care Planning; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Area; Attention; Black American; Caring; Cognition; Communities; Consultations; Credentialing; Data; Data Analyses; Data Collection; Data Linkages; Data Scientist; Dementia; Development; Diagnosis; Disadvantaged; Disparity; Elderly; Ensure; Ethnic Origin; Ethnic Population; Evaluation; Exposure to; Fall prevention; Family Caregiver; Family Practice; Fracture; Friends; Health; Health Policy; Health Services; Health system; Healthcare; High Prevalence; Hispanic; Hispanic Americans; Impaired cognition; Independent Living; Internal Medicine; International; Internist; Interview; Link; Medicare; Mental Depression; Methods; Nurse Practitioners; Nurses; Outcome; Patients; Persons; Pharmaceutical Preparations; Physical environment; Physicians; Policies; Practice Guidelines; Preventive service; Primary Care; Race; Random Allocation; Recommendation; Reduce health disparities; Rehabilitation therapy; Research Design; Research Personnel; Retirement; Risk Assessment; Rural; Sampling; Scientist; Self Care; Sex Differences; Social Work; Socioeconomic Status; Surveys; Telephone; Texas; United States Centers for Medicare and Medicaid Services; Visit; Woman; Work; acute care; beneficiary; black men; black women; cost; dementia care; disparity reduction; ethnic difference; fall risk; falls; family caregiving; health care quality; health care service; health disparity; high risk; improved; individualized prevention; interest; men; outcome disparities; prevent; racial difference; racial population; research study; sex; socioeconomics; sound; trend; urban residence

PROJECT SUMMARY/ABSTRACT Early recognition of cognitive impairment and timeliness in Alzheimer’s Disease and Related Dementias (ADRD) diagnoses are key to optimal dementia care. Data show that early ADRD recognition is linked to less exposure to potentially inappropriate medications (PIM), less propensity for acute care use, lower rates of falls, and increased adoption of advance care planning. One potential way to improve early recognition of ADRD is Annual Wellness Visits (AWVs)—a free preventive service that covers cognition and fall risk assessment, medication reconciliation, and personalized prevention plans. The Centers for Medicare & Medicaid Services (CMS) began reimbursing AWVs in 2011. The Alzheimer’s Association (AA) has drawn attention to the higher prevalence and risk of ADRD among women than men and black and Hispanic Americans than whites. Receipt of AWVs might decrease health disparities; however, evidence to date is inconsistent. This 5-year R01 project has a focus on community-dwelling ADRD patients and is based on the Institute for Healthcare Improvement’s 4Ms framework of an age-friendly health system, 4Ms: what matters, mentation, mobility, and medication. We will conduct a convergent parallel mixed-methods design research study to assess the effect of AWV policy on early ADRD diagnosis and reducing health disparities. We will analyze national Medicare data, health retirement survey-Medicare linkage data, and National Health & Aging Trends study-Medicare linkage data to understand the effect of AWV implementation on reducing health disparities across sex, racial/ethnic, socioeconomic status, and rural/urban residence. Also, we will collect primary data (phone interviews) from 180 family caregivers of ADRD patients (~30 in each of the 6 groups: Hispanic men, Hispanic women, black men, black women, white men, and white women) and 400 clinicians (~100 in each of 4 Medicare regions, ~25 in each of 4 credential areas: family medicine, internal medicine primary care, geriatricians, nurse practitioners) to understand how AWV is delivered to ADRD patients in order to identify the potential mechanism for reducing health disparity through AWV. For family caregivers, we will use a snowball sampling method with AA’s and Rotary International networks, and AA’s TrialMatch® platform to reach potential subjects nationwide. For clinicians, we will randomly select clinicians nationwide from the 2019 CMS doctors and clinicians national file. We will partner with AA to ensure sound data collection and development of practical implications to inform policy/practice. Our three specific aims are: Aim 1: Assess the effects of AWV on the timeliness of ADRD diagnosis (mentation); Aim 2: Assess the effects of AWV on advance care planning consultation (what matters), depression (mentation), fall and fracture (mobility), and PIM use and ADRD treatment (medication) for ADRD patients across sex, racial/ethnic, socioeconomic status, and rural/urban residence; and Aim 3: Identify what works and what does not work in AWV delivery for ADRD patients.

项目概要/摘要 早期识别阿尔茨海默病和相关痴呆症的认知障碍和及时性 (ADRD) 诊断是最佳痴呆症护理的关键 数据显示，早期 ADRD 识别与较少相关。 接触潜在不适当药物 (PIM)、较少使用急性护理的倾向、较低的跌倒率、 提高 ADRD 早期识别率的一种潜在方法是增加预先护理计划的采用。 年度健康访问 (AWV)——一项免费的预防服务，涵盖认知和跌倒风险评估、 药物协调和个性化预防计划。 医疗保险和医疗补助服务中心。 (CMS) 于 2011 年开始报销 AWV。阿尔茨海默病协会 (AA) 已提请注意高级 女性 ADRD 患病率和风险高于男性，黑人和西班牙裔美国人高于白人。 AWV 可能会减少健康差异；然而，迄今为止的证据并不一致。 这个为期 5 年的 R01 项目重点关注社区居住的 ADRD 患者，以研究所为基础 医疗保健改善的老年友好型卫生系统 4Ms 框架，4Ms：重要的事情、心态、 我们将进行收敛并行混合方法设计研究。 评估 AWV 政策对早期 ADRD 诊断和减少健康差异的影响。 国家医疗保险数据、健康退休调查-医疗保险联动数据以及国家健康与老龄化趋势 研究-医疗保险关联数据，以了解 AWV 实施对减少健康差距的影响 此外，我们还将收集主要数据，涵盖性别、种族/民族、社会经济地位和农村/城市居住地。 （电话采访）来自 ADRD 患者的 180 名家庭护理人员（6 组中每组约 30 名：西班牙裔男性、 西班牙裔女性、黑人男性、黑人女性、白人男性和白人女性）和 400 人（每个人约 100 人） 4 个医疗保险区域，4 个证书领域各约 25 个区域：家庭医学、内科初级保健、 老年病学家、执业护士）了解如何将 AWV 传递给 ADRD 患者，以确定 通过 AWV 减少健康差距的潜在机制 对于家庭护理人员，我们将使用滚雪球。 AA 和 Rotary International 网络以及 AA 的 TrialMatch® 平台的抽样方法，以达到 全国范围内的潜在课题。 我们将与 AA 合作，确保健全的数据收集和开发。 我们的三个具体目标是： 目标 1：评估 AWV 对 ADRD 诊断及时性（心理状态）的影响； 目标 2：评估 AWV 对预先护理计划咨询（重要事项）、抑郁症的影响 （精神状态）、跌倒和骨折（活动能力）以及针对 ADRD 的 PIM 使用和 ADRD 治疗（药物） 不同性别、种族/民族、社会经济地位和农村/城市居住地的患者；以及 目标 3：确定 AWV 治疗对 ADRD 患者有效和无效的方法。