The Coming Home After Rehabilitation and Transition from a Skilled nursing facility with Dementia Study (The CHARTS-D Study)

痴呆症研究（CHARTS-D 研究）从熟练护理机构康复和过渡后回家

• 批准号: 10092062
• 负责人: Jennifer Lynn Carnahan
• 金额: $ 18.15万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-02-01 至 2025-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10092062
• 关键词: Accident and Emergency department; Age; Aging; Alzheimer' s disease related dementia; Ambulatory Care; Attention; Back; Caregivers; Caring; Characteristics; Clinic Visits; Complex; Computerized Medical Record; Data; Data Set; Dementia; Development Plans; Diagnosis; Economics; Elderly; Event; Funding; Future; Gender; Goals; Health; Health Policy; Health and Retirement Study; Healthcare; Home; Home Care Services; Hospitalization; Hospitals; Impaired cognition; Income; Indiana; Individual; Injury; Intervention; Intervention Trial; Interview; Length of Stay; Link; Measures; Medical; Medicare/Medicaid; Medication Errors; Modeling; Outcome; Outcome Assessment; Outpatients; Patient Readmission; Patient-Focused Outcomes; Patients; Physical Function; Population Heterogeneity; Quality of Care; Rehabilitation therapy; Research; Research Methodology; Research Personnel; Risk; Scholarship; Severities; Skilled Nursing Facilities; Social isolation; Time; Training; United States Centers for Medicare and Medicaid Services; Visit; Work; acute care; adverse outcome; billing data; career development; dementia care; experience; follow-up; functional decline; health care service utilization; health care settings; high risk; home based service; hospital readmission; improved; insight; patient home care; posthospitalization care; prevent; primary outcome; readmission risk; secondary outcome; social; support network; therapy design

Increasing numbers of patients with Alzheimer’s disease and related dementias (ADRD) are receiving post- hospitalization care in skilled nursing facilities (SNFs). Most will transition from the SNF to home. Although there has been a great deal of attention paid to patients’ transition from the hospital to home, there has been little research on transitions from the SNF to home. Experiencing multiple transitions from home to the hospital to a SNF and back to home is difficult for patients with ADRD and their caregivers. After discharge from SNF to home, patients may re-enter the cycle of transitions, suffering adverse outcomes such as hospital readmissions, medication errors, functional decline, and loss of independence. This project will identify factors associated with 30-day hospital readmission and other adverse outcomes for patients with ADRD who transition from the SNF to home. We will use the Health and Retirement Study (HRS), a large, national dataset that includes rich social and economic information that is pertinent to the risk of adverse health outcomes. Our study takes advantage of the link between the HRS and Centers for Medicare and Medicaid Services billing data, and especially the link to extensive data collected during SNF stay as part of the Minimum Data Set and home health event data from the Outcome and Assessment Information Set. For Aim 1, we will describe the relationship of ADRD diagnosis or severity of cognitive impairment in the SNF with hospital readmission for patients who transition from SNF to home. We hypothesize that individuals with ADRD are at greater risk of hospital readmission when controlling for Andersen model factors. We also propose that worse levels of cognitive impairment, as measured during a patient’s stay in the SNF, will be associated with greater risk readmission risk. For Aim 2, we will identify the effect of early outpatient care, either in clinic visit or via home health visit, on reducing readmissions. We hypothesize that early outpatient care is protective against readmission. This represents a first step in identifying interventions to reduce readmissions for people with ADRD who undergo this complex healthcare trajectory. Dr. Carnahan’s career development plan will provide thorough training in research methods and health policy related to transitions for older adults with ADRD. As an emerging aging researcher with expertise in the SNF to home care transition, Dr. Carnahan will use the results of this study to design an intervention that improves the health outcomes of cognitively impaired patients who experience this complex healthcare trajectory. Her long term goal is to improve the quality of care and health outcomes for older adults with ADRD.

越来越多的阿尔茨海默病和相关痴呆症 (ADRD) 患者正在接受术后治疗 大多数护理机构将从 SNF 过渡到家庭护理。 人们对患者从医院到家的过渡给予了极大的关注， 关于从 SNF 到家庭的过渡的研究很少。 经历从家庭到医院的多次过渡。 对于 ADRD 患者及其护理人员来说，从 SNF 出院后返回 SNF 并回家是很困难的。 在家中，患者可能会重新进入过渡循环，遭受住院等不良后果 再入院、用药错误、功能衰退和丧失独立性。 该项目将确定与 30 天再入院和其他不良后果相关的因素 从 SNF 过渡到家庭的 ADRD 患者 我们将使用健康与退休研究 (HRS)， 一个大型的国家数据集，其中包含与风险相关的丰富的社会和经济信息 我们的研究利用了 HRS 和医疗保险中心之间的联系。 和医疗补助服务账单数据，尤其是 SNF 停留期间收集的大量数据的链接 来自结果和评估信息集的最小数据集和家庭健康事件数据。 对于目标 1，我们将描述 ADRD 诊断或 SNF 中认知障碍严重程度的关系 我们对从 SNF 过渡到家庭的患者重新入院进行追踪。 当控制安德森模型因素时，ADRD 再次入院的风险更大。 提出，在患者入住 SNF 期间测量到的认知障碍程度会更严重 对于目标 2，我们将确定早期门诊护理的效果， 无论是在诊所就诊还是通过家庭健康就诊，我们都与早期门诊患者进行了接触。 护理可以防止再次入院，这是确定干预措施以减少再次入院的第一步。 经历这种复杂的医疗保健轨迹的 ADRD 患者的重新入院。 卡纳汉博士的职业发展计划将提供研究方法和卫生政策方面的全面培训 作为一名具有 SNF 专业知识的新兴老龄化研究人员，与患有 ADRD 的老年人的过渡相关。 家庭护理过渡后，卡纳汉博士将利用这项研究的结果来设计一种干预措施，以改善 经历这种复杂的医疗保健轨迹的认知障碍患者的健康结果。 长期目标是提高患有 ADRD 的老年人的护理质量和健康结果。