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.

项目摘要/摘要 早期认识阿尔茨海默氏病和相关痴呆症的认知障碍和及时性 （ADRD）诊断是最佳痴呆护理的关键。数据表明，早期的ADRD识别与更少的 暴露于潜在的不当药物（PIM），急性护理使用的前景较小，跌倒率较低， 并增加了预先护理计划的采用。提高早期认识ADRD的一种潜在方法是 年度健康访问（AWVS） - 一种涵盖认知和跌倒风险评估的免费预防服务， 药物对帐和个性化预防计划。医疗保险和医疗补助服务中心 （CMS）在2011年开始报销AWV。阿尔茨海默氏症协会（AA）引起了人们的注意 女性的患病率和风险比男性，黑人和西班牙裔美国人比白人多。收据 AWV可能会减少健康分布；但是，迄今为止的证据是不一致的。 这个为期5年的R01项目专注于社区居住的ADRD患者，并基于研究所 医疗保健改善的4MS框架框架友好型卫生系统，4ms：重要的是，导师， 流动性和药物。我们将进行收敛的平行混合方法设计研究 评估AWV政策对ADRD早期诊断的影响并减少健康差异。我们将分析 国家医疗保险数据，卫生退休调查媒体链接数据以及国家卫生与老龄化趋势 研究中的链接数据以了解AWV实施对减少健康分布的影响 跨性别，种族/种族，社会经济地位以及粗糙/城市居住。另外，我们将收集主要数据 （电话访谈）来自180名ADRD患者的家庭护理人员（6组中的每一个约30名：西班牙裔男子， 西班牙裔女人，黑人男人，黑人妇女，白人和白人妇女）和400名临床医生（每个 4个Medicare地区，在4个凭证领域中的每个区域〜25：家庭医学，内科医学初级保健， 老年医生，护士从业人员）了解如何将AWV交付给ADRD患者以确定 通过AWV降低健康差异的潜在机制。对于家庭护理人员，我们将使用雪球 使用AA和旋转国际网络的采样方法，以及AA的TrialMatch®平台到达 全国潜在的主题。对于临床医生，我们将从2019 CMS中随机选择全国的临床医生 医生和临床医生国家文件。我们将与AA合作，以确保合理的数据收集和开发 为政策/实践提供信息的实际意义。我们的三个具体目标是： AIM 1：评估AWV对ADRD诊断及时性的影响（METINGITINITIND）； 目标2：评估AWV对预先护理计划咨询（重要的），抑郁症的影响 （介绍），秋季和断裂（流动性）以及ADRD的PIM使用和ADRD治疗（药物） 跨性别，种族/种族，社会经济地位和农村/城市居住的患者；和 AIM 3：确定ADRD患者的AWV交付中有效的方法以及什么不起作用。