Effect of Hospital and Community Care Coordination on Health Care Access, Quality and Equity among Individuals with Risk Factors or Diagnosis of ADRD

医院和社区护理协调对有 ADRD 危险因素或诊断的个人的医疗保健获取、质量和公平性的影响

• 批准号: 9789164
• 负责人: Jie Chen
• 金额: $ 34.61万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2021-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9789164
• 关键词: Address; Adult; Affect; African American; Age; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Alzheimer' s disease risk; Area; Caring; Cholesterol; Chronic Care; Chronic Disease; Cognitive; Communities; Community Hospitals; Continuity of Patient Care; Critical Care; Data; Data Set; Databases; Dementia; Diabetes Mellitus; Diagnosis; Disease; Disease Progression; Elderly; Ensure; Face; Goals; Health; Health Promotion; Health system; Healthcare; Healthcare Systems; Hispanics; Homelessness; Hospitals; Housing; Hypertension; Improve Access; Individual; Information Systems; Investments; Latino; Life Style; Link; Literature; Longitudinal Studies; Medicare; Medicare claim; Minority; Mission; Obesity; Organizational Models; Outcome; Patients; Policy Maker; Population; Primary Health Care; Public Health; Quality of Care; Research; Resources; Risk Factors; Savings; Services; Smoking; Social Environment; Surveys; System; Time; U.S. Department of Housing and Urban Development; Underserved Population; Variant; base; beneficiary; care coordination; cost; cost effective; data sharing; dementia care; dementia risk; disorder control; economic incentive; effective care management; ethnic minority population; experience; financial incentive; health care availability; health care quality; health disparity; improved; innovation; interest; mild cognitive impairment; modifiable risk; multidisciplinary; neglect; organizational structure; personalized care; personalized health care; population health; preference; programs; racial and ethnic disparities; racial minority; socioeconomics

SUMMARY Disparity populations, in particular aging African-Americans and Hispanics (65 years and older), are significantly more likely to have Alzheimer’s disease and related dementia (ADRD) than older Whites in the same age range. Delays in accessing timely primary care, lack of care coordination, and variations in lifestyle and socioeconomic conditions are considered as major factors that contribute to racial and ethnic disparities. Health care coordination, such as chronic care management and post-hospital discharge continuity of care programs, has been identified as a critical component in improving quality of care and patient experience. In addition, Accountable Care Organizations (ACOs) have been proposed to promote care coordination through team-based approaches and financial incentives. However, little is known about how these system-level care coordination strategies have improved health care access, quality and equity for populations with ADRD. The objective of our project is to determine best hospital-community care coordination practices that can improve effective management of ADRD and co-existing conditions; control/reduce modifiable risk factors of ADRD and administer health care for these diseases in early stages; and eventually promote population health and reduce health disparities. Our primary hypothesis is that integrating hospital and community care can improve quality and equity among people with ADRD as well as cognitively healthy older adults at increased risk for ADRD. We will leverage our comprehensive, national data on care coordination, and construct a multi-level data set (individual-, hospital/ACO-, community-, and state- level) by linking Medicare claims data and Shared Savings Program Accountable Care Organizations data to address our primary hypothesis. Using a population-level longitudinal study (2012-2018), we aim to identify the influences of care coordination practices and ACOs on health care access, quality, and cost for people with ADRD and older adults at increased risk for ADRD (including adults living with diabetes, hypertension, high cholesterol, obesity, smoking, and mild cognitive impairment) (Aims 1 and 2); estimate the impact of care coordination on one of the hardest-to-reach populations: racial and ethnic minority populations who received federal housing assistance (who may have experienced periods of homelessness) (Aim 3); and highlight care coordination practices and the ACO models that can reduce racial and ethnic disparities (Aim 4). Our multidisciplinary, systems-based approach will enable us to identify the most critical care coordination practices that will have the greatest impact on increasing effective care for minority patients with ADRD; and control diseases in early stages among those with ADRD risk factors. Our results will provide policy makers with critical information on how to utilize existing resources to integrate care coordination across the health care system to ensure that minorities get access to the most appropriate and effective care. The goal aligns with the National Plan to Address Alzheimer's Disease that aims to enhance care quality and efficiency.

概括 差异人群，尤其是衰老的非裔美国人和西班牙裔（65岁以上） 在 年龄范围相同。延迟获得及时的初级保健，缺乏护理协调和生活方式的差异 社会经济条件被认为是导致种族和种族差异的主要因素。 医疗保健协调，例如慢性护理管理和院后护理后连续性 计划被确定为改善护理质量和患者经验的关键组成部分。在 此外，已提出了负责任的护理组织（ACO），以通过 基于团队的方法和经济激励措施。但是，对于这些系统级护理如何了解 协调策略改善了ADRD人口的医疗保健访问，质量和公平性。 我们项目的目的是确定可以改善的最佳医院社区护理协调惯例 有效管理ADRD和共存条件；控制/减少ADRD的可修改风险因素 在早期为这些疾病管理医疗保健；并最终促进人口健康并减少 健康差异。我们的主要假设是，整合医院和社区护理可以提高质量 ADRD和认知健康的老年人的平等和股权增加了ADRD的风险。 我们将利用我们有关护理协调的全面，国家数据，并构建多层数据集 （个人，医院/ACO-，社区和州级）通过将Medicare索赔数据和共享储蓄联系起来 计划负责任的护理组织数据以解决我们的主要假设。使用人群级别 纵向研究（2012-2018），我们旨在确定护理协调实践和ACO对 ADRD和老年人的医疗保健访问，质量和成本，ADRD风险增加 （包括患有糖尿病的成年人，高血压，高胆固醇，肥胖，吸烟和轻度认知 损害）（目标1和2）；估计护理协调对最难到达之一的影响 人口：获得联邦住房援助的种族和少数民族人口（可能有 经验丰富的无家可归时期）（目标3）；并突出显示护理协调实践和ACO模型 这可以减少种族和种族差异（目标4）。我们的多学科，基于系统的方法将启用 我们确定最重要的护理协调惯例，这些实践将对增加产生最大的影响 为ADRD患有少数民族患者的有效护理；在患有ADRD的患者的早期阶段控制疾病 风险因素。我们的结果将为政策制定者提供有关如何利用现有资源的关键信息 整合整个医疗保健系统的护理协调，以确保少数民族获得最多的机会 适当有效的护理。该目标与国家计划解决阿尔茨海默氏病的计划保持一致 旨在提高护理质量和效率。