R01 Upstream Approaches to Improve Late Life Care for People Living with Dementia

R01 改善痴呆症患者晚年护理的上游方法

基本信息

批准号：
10063298
负责人：
Olga F. Jarrín Montaner
金额：
$ 57.32万
依托单位：
RBHS-SCHOOL OF NURSING
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10063298
关键词：
Activities of Daily Living Address Admission activity Alzheimer&apos s Disease Alzheimer&apos s disease diagnosis Area Behavioral Caring Cessation of life Clinical Communities Complex Data Data Set Dementia Development Diagnosis Disadvantaged Elderly Evaluation Exposure to Family Family Caregiver Female Frequencies Goals Health Health Services Accessibility Health system Home Care Services Home Health Agency Home environment Hospitalization Hospitals Ice Individual Inpatients Institutes Intervention Length Level of Evidence Life Link Medical Medicare Medicare/Medicaid Modeling Neighborhoods Outcome Population Public Health Quality Indicator Quality of Care Reproducibility Research Research Personnel Risk Role Rural Specific qualifier value Structure Subgroup Symptoms Testing Variant Work advanced disease base behavioral health beneficiary cognitive function dementia care design disadvantaged population disparity reduction end of life end of life care ethnic difference ethnic disparity ethnic minority population experimental study health care availability health care disparity health care service utilization health disparity health service use hospice environment improved innovation male minority health multilevel analysis novel population health prevent racial and ethnic racial and ethnic disparities racial difference racial minority socioeconomic disadvantage survival outcome treatment disparity

项目摘要

PROJECT SUMMARY The long-term goal is to improve the quality of end-of-life care provided to families and people living with Alz- heimer’s disease and its related dementias (dementia) by generating population-level evidence on the public health impact of community-based support structures including skilled home health care. Alzheimer’s Disease diagnosis in racial and ethnic minority populations is projected to more than double by 2030. Large racial and ethnic differences and disparities exist in well-established end-of-life care quality indicators (inpatient admis- sions, hospice use, place of death), and in people living with dementia some of these differences may be com- pounded. One understudied approach to improving dementia care among racial/ethnic minority and socioeco- nomically disadvantaged populations is the use of skilled home health care (a benefit under Medicare and Medicaid). The short-term goal for this R01 is to define racial/ethnic differences in the effects of skilled home health care on indicators of end-of-life care quality (e.g., inpatient admissions, use of hospice, and place of death) as a function of dementia diagnosis. The central hypothesis is that “upstream” exposure to home health care prior to and during the final year of life has a cumulative and beneficial effect on "downstream” end-of-life care quality indicators: (1) inpatient admissions, (2) hospice utilization, and (3) place of death. The scientific premise for this work is that PLwD have complex medical and behavioral health needs, and many rely on fam- ily caregivers to help with activities of daily living and coordination of medical care. Too few benefit from skilled home health care. As cognitive function deteriorates from mild symptoms and behavioral changes to more ad- vanced illness, skilled home health care may help prevent avoidable hospitalizations, and minimize burden- some transitions across care settings at the end-of-life. The central hypothesis will be tested by pursing three specific aims: Examine the relationship between receiving skilled home health care prior to and during the last year of life and: 1) inpatient admissions (type, frequency and length) in the last year of life, 2) hospice utiliza- tion (timing and setting) in the last year of life, and 3) place of death (e.g., hospital, home, hospice in a hospital, hospice at home). The aims will be tested using linked Medicare data sets to examine the effect of skilled home health care utilization on racial and ethnic disparities in end-of-life outcomes among people diagnosed with dementia compared to people not diagnosed with dementia. The research proposed in this application is innovative, in the applicant’s opinion, because it focuses on evaluating an underutilized core benefit of Medi- care through evaluating the effect of skilled home health care access on disparities in dementia care quality. Successful completion of proposal aims will have a sustained and powerful impact by providing needed and actionable evidence to reduce disparities in care for racial and ethnic minority older adults living with dementia. The project will significantly impact the design, development, and evaluation of population health system inter- ventions to eliminate or reduce disparities in care and end-of-life outcomes among people living with dementia.

项目概要长期目标是提高为患有阿尔茨海默氏症的家庭和患者提供的临终关怀质量通过向公众提供人口层面的证据来研究海默氏病及其相关痴呆症（痴呆症）基于社区的支持结构（包括熟练的家庭医疗保健）对健康的影响。预计到 2030 年，少数种族和族裔人口的诊断率将增加一倍以上。完善的临终关怀质量指标（住院患者入院）中存在种族差异和差异病、临终关怀使用、死亡地点），而对于痴呆症患者来说，其中一些差异可能是一种尚未得到充分研究的改善种族/族裔和社会经济的痴呆症护理的方法。经济上处于不利地位的人群的一个好处是使用熟练的家庭医疗保健（医疗保险和医疗保险的一项福利） R01 的短期目标是确定种族/民族差异对技术家庭的影响。临终关怀质量指标的卫生保健（例如住院、临终关怀的使用以及临终关怀地点）死亡）作为痴呆症诊断的一个函数，核心假设是家庭健康的“上游”暴露。生命最后一年之前和期间的护理对“下游”生命终结具有累积和有益的影响护理质量指标：(1) 住院人数，(2) 临终关怀服务利用率，(3) 死亡地点。这项工作的前提是 PLwD 具有复杂的医疗和行为健康需求，并且许多人依赖家庭能够帮助日常生活活动和协调医疗护理的护理人员很少。随着认知功能从轻微症状和行为变化发展为更多的家庭保健。严重疾病、熟练的家庭保健可能有助于避免可预防的住院治疗，并最大程度地减轻负担临终时护理环境的一些转变将通过追求三个来检验。具体目标：检查在最后一次之前和期间接受熟练的家庭医疗保健之间的关系生命年份以及： 1) 生命最后一年的住院情况（类型、频率和持续时间），2) 临终关怀中心的利用情况生命最后一年的死亡（时间和地点），以及 3) 死亡地点（例如医院、家、医院临终关怀中心、家庭临终关怀）将使用链接的医疗保险数据集来测试目标，以检查熟练的效果。家庭医疗保健利用对被诊断者临终结果的种族和民族差异的影响患有痴呆症的人与未诊断出患有痴呆症的人相比，本申请中提出的研究是。申请人认为，这是创新的，因为它侧重于评估医疗未充分利用的核心效益通过评估熟练的家庭医疗保健获取对痴呆症护理质量差异的影响来提供护理。成功完成提案目标将通过提供所需和减少对患有痴呆症的种族和族裔少数老年人的护理差异的可行证据。该项目将对人口卫生系统的设计、开发和评估产生重大影响旨在消除或减少痴呆症患者护理和临终结果方面的差异的干预措施。