Telemedicine and health disparities among community-dwelling older adults with ADRD during COVID-19 pandemic

COVID-19 大流行期间社区居住的 ADRD 老年人的远程医疗和健康差异

• 批准号: 10247305
• 负责人: Shubing Cai
• 金额: $ 144.52万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10247305
• 关键词: Accounting; Acute; Adopted; Affect; Alzheimer' s disease related dementia; Ambulatory Care; Behavioral Symptoms; COVID-19; COVID-19 mortality; COVID-19 pandemic; Caregivers; Caring; Chronic; Communities; Data; Dementia; Devices; Dimensions; Educational Background; Elderly; Emergency department visit; Ethnic Origin; Event; Exposure to; Face; Future; Health; Health Services Accessibility; Healthcare; High Prevalence; Hispanics; Hospitalization; Impaired cognition; Individual; Infection; Interruption; Interview; Lead; Measures; Medicare; Methods; Older Population; Outpatients; Persons; Plant Roots; Policies; Population; Primary Health Care; Psychiatry; Public Health; Public Policy; Race; Reporting; Research; Risk; Role; SARS-CoV-2 infection; Series; Services; Socioeconomic Status; Statistical Models; Telemedicine; Telephone; Testing; Time; United States Centers for Medicare and Medicaid Services; Variant; Visit; Vulnerable Populations; beneficiary; burden of illness; comorbidity; coronavirus disease; digital; ethnic minority population; experience; health care service utilization; health disparity; high risk; improved; informal caregiver; innovation; medical specialties; outpatient programs; pandemic disease; prevent; psychological symptom; racial and ethnic; racial and ethnic disparities; racial health disparity; treatment as usual; Accounting; Acute; Adopted; Affect; Alzheimer' s disease related dementia; Ambulatory Care; Behavioral Symptoms; COVID-19; COVID-19 mortality; COVID-19 pandemic; Caregivers; Caring; Chronic; Communities; Data; Dementia; Devices; Dimensions; Educational Background; Elderly; Emergency department visit; Ethnic Origin; Event; Exposure to; Face; Future; Health; Health Services Accessibility; Healthcare; High Prevalence; Hispanics; Hospitalization; Impaired cognition; Individual; Infection; Interruption; Interview; Lead; Measures; Medicare; Methods; Older Population; Outpatients; Persons; Plant Roots; Policies; Population; Primary Health Care; Psychiatry; Public Health; Public Policy; Race; Reporting; Research; Risk; Role; SARS-CoV-2 infection; Series; Services; Socioeconomic Status; Statistical Models; Telemedicine; Telephone; Testing; Time; United States Centers for Medicare and Medicaid Services; Variant; Visit; Vulnerable Populations; beneficiary; burden of illness; comorbidity; coronavirus disease; digital; ethnic minority population; experience; health care service utilization; health disparity; high risk; improved; informal caregiver; innovation; medical specialties; outpatient programs; pandemic disease; prevent; psychological symptom; racial and ethnic; racial and ethnic disparities; racial health disparity; treatment as usual

Project Summary. Community-dwelling older adults with ADRD face significant challenges under the pandemic of COVID-19: they are not only at high risks for COVID-19 infection and mortality, but also at high risks for the negative consequences of a disruption in usual outpatient care. Older adults with ADRD have high care needs and rely on timely and regular outpatient care to manage ADRD and other co-exiting conditions. The consequence of disruption in usual care could be even greater among racial/ethnic minorities with ADRD, as Blacks and Hispanics generally have a greater disease burden than their white counterparts. To improve care access, the CMS expanded the coverage of telemedicine in March 2020. Although there has been significant increase in the telemedicine use since then, it is unknown how the CMS' telemedicine policy affects care among community-dwelling older adults with ADRD; and how it varies by racial/ethnic minorities. Indeed, there are concerns that the telemedicine policy may widen racial/ethnic disparities in health care. Therefore, the main objective of this proposed research is to understand the effect of CMS' telemedicine policy on health care utilization that are not directly related to COVID among community-dwelling older adults with ADRD, and its variations by race/ethnicity. This study has 3 Specific Aims: SA1.To examine racial/ethnic disparities in the utilization of usual outpatient care among community-dwelling older adults with ADRD, before and after changes in CMS telemedicine policy. We hypothesize that Blacks and Hispanics have fewer usual outpatient visits than whites after the implementation of telemedicine policy, accounting for prior health care utilization. We will examine the utilization of usual outpatient care from several dimensions. SA2.To examine racial/ethnic disparities in the relationship between the telemedicine policy and ambulatory care sensitive (ACS) hospitalizations, emergency room (ER) visits and observation stays. We hypothesize that racial/ethnic minorities with ADRD are less likely to benefit from the expansion of telemedicine, in preventing these ACS acute events. We will also examine how the disparities, if detected, are affected by the access to telemedicine. Several statistical models (e.g. interrupted time series regression) will be adopted and stratified analyses (by state and socio-economic status of a community) will be performed for SA 1&2. SA3. To explore caregivers' perspectives regarding benefits, barriers and challenges of telemedicine use among white, Black and Hispanic community-dwelling older adults with ADRD. This proposed research is innovative because it is the first study to examine racial/ethnic disparities in the relationship between the telemedicine policy and health care utilization among community-dwelling older adults with ADRD, by using a mixed-method approach. This proposed study is significant because findings will provide information on improving care equity among ADRD population, both during the pandemic and beyond. Findings will also provide the premise for future studies to collect data on a larger scale to understand the root cause in health disparities among this population.

项目摘要。居住在社区的老年人面临着巨大的挑战 COVID-19的大流行：它们不仅处于Covid-19感染和死亡率的高风险，而且还处于高风险 常规门诊护理中断的负面后果的风险。 ADRD的老年人很高 护理需求，并依靠及时，定期的门诊护理来管理ADRD和其他共外面条件。 在ADRD的种族/少数民族中，在常规护理中造成的干扰可能会更大， 由于黑人和西班牙裔通常比白人同行具有更大的疾病负担。改进 护理访问，CMS在2020年3月扩大了远程医疗的覆盖范围。 从那时起，远程医疗的使用显着增加，尚不清楚CMS的远程医疗政策如何 影响ADRD的社区居住老年人的护理；以及种族/种族的变化 少数民族。确实，人们担心远程医疗政策可能会扩大种族/种族差异 卫生保健。因此，这项拟议的研究的主要目的是了解CMS的影响 医疗保健利用的远程医疗政策与社区居民之间的共同关系无直接关系 患有ADRD的老年人及其种族/种族的变化。这项研究具有3个具体目标：SA1。检查 在社区居住的老年人中，种族/种族差异用于使用常规门诊护理 ADRD，在CMS远程医疗政策发生变化之前和之后。我们假设黑人和西班牙裔有 实施远程医疗政策后，通常的门诊就诊少于白人 医疗保健利用。我们将从几个维度检查使用通常的门诊护理的利用。 sa2.to 检查远程医疗政策与门诊护理之间关系中的种族/种族差异 敏感（ACS）住院，急诊室（ER）就诊和观察。我们假设这一点 具有ADRD的种族/族裔少数族裔不太可能从远程医疗的扩张中受益，以防止 这些ACS急性事件。我们还将研究差异（如果检测到）如何受到访问的影响 远程医疗。将采用几种统计模型（例如，时间序列回归中断）并分层 SA 1和2将对分析（按社区的州和社会经济地位进行分析）。 SA3。探索 看护人对白色，黑色远程医疗使用的好处，障碍和挑战的看法 以及与ADRD的西班牙裔社区老年人。这项拟议的研究具有创新性，因为它是 远程医疗政策与健康之间关系中的种族/种族差异的第一项研究 使用混合方法方法，使用ADRD的社区老年人的护理利用。这 拟议的研究很重要，因为发现将提供有关改善ADRD护理权益的信息 人口，无论是在大流行期间还是在大流行期间。调查结果还将为以后的研究提供前提 收集大规模的数据，以了解该人群健康差异的根本原因。