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

基本信息

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
项目类别：
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&apos 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

项目摘要

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。居住在社区的患有 ADRD 的老年人面临着巨大的挑战 COVID-19 大流行：他们不仅是感染 COVID-19 和死亡的高风险人群，而且也是高风险人群常规门诊护理中断造成负面后果的风险。患有 ADRD 的老年人患病率较高护理需求，并依靠及时和定期的门诊护理来管理 ADRD 和其他共存疾病。对于患有 ADRD 的少数种族/族裔来说，常规护理中断的后果可能更大，因为黑人和西班牙裔通常比白人承受更大的疾病负担。改善 CMS 于 2020 年 3 月扩大了远程医疗的覆盖范围。此后远程医疗的使用显着增加，目前尚不清楚 CMS 的远程医疗政策如何影响社区居住的 ADRD 老年人的护理；以及它如何因种族/民族而变化少数民族。事实上，有人担心远程医疗政策可能会扩大种族/民族差异卫生保健。因此，本研究的主要目的是了解 CMS 的效果关于社区居民中与新冠疫情不直接相关的医疗保健利用的远程医疗政策患有 ADRD 的老年人及其种族/民族的差异。这项研究有 3 个具体目标： SA1. 检验社区居住的老年人在使用常规门诊护理方面存在种族/民族差异 ADRD，CMS 远程医疗政策变更前后。我们假设黑人和西班牙裔实施远程医疗政策后，日常门诊量比白人少，占之前的比例医疗保健利用。我们将从几个维度考察平时门诊的利用情况。 SA2.To 检查远程医疗政策与门诊护理之间关系的种族/民族差异敏感 (ACS) 住院、急诊室 (ER) 就诊和观察住院。我们假设患有 ADRD 的少数种族/族裔不太可能从远程医疗的扩展中受益，因为这些 ACS 急性事件。我们还将研究这些差异（如果被发现）如何受到访问权限的影响。远程医疗。将采用多种统计模型（例如中断时间序列回归）并进行分层将对 SA 1 和 2 进行分析（按社区的州和社会经济状况）。 SA3。探索护理人员对白人、黑人使用远程医疗的好处、障碍和挑战的看法居住在社区的西班牙裔患有 ADRD 的老年人。这项拟议的研究具有创新性，因为它第一项研究远程医疗政策与健康之间关系的种族/民族差异通过使用混合方法，评估患有 ADRD 的社区老年人的护理利用情况。这拟议的研究意义重大，因为研究结果将提供有关改善 ADRD 患者护理公平性的信息人口，无论是在大流行期间还是之后。研究结果也将为未来的研究提供前提收集更大规模的数据，以了解该人群健康差异的根本原因。

项目成果

期刊论文数量（8）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Post-acute care transitions and outcomes among Medicare beneficiaries with dementia: Associations with race/ethnicity and dual status.

患有痴呆症的医疗保险受益人的急性后护理转变和结果：与种族/民族和双重身份的关联。

DOI：
10.1111/1475-6773.14059
发表时间：
2023
期刊：
Health services research
影响因子：
3.4
作者：
Temkin-Greener,Helena;Yan,Di;Cai,Shubing
通讯作者：
Cai,Shubing

Primary Care Telemedicine Use among Assisted Living Residents with Dementia during COVID-19: Race and Dual Enrollment Status.

DOI：
10.1016/j.jamda.2023.05.005
发表时间：
2023-08
期刊：
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
影响因子：
7.6
作者：
Hua, Yechu;Temkin-Greener, Helena;Cai, Shubing
通讯作者：
Cai, Shubing

Racial/Ethnic Differences in Risk Factors Associated With Severe COVID-19 Among Older Adults With ADRD.

DOI：
10.1016/j.jamda.2023.02.111
发表时间：
2023-06
期刊：
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
影响因子：
7.6
作者：
Qin, Qiuyuan;Veazie, Peter;Temkin-Greener, Helena;Makineni, Rajesh;Cai, Shubing
通讯作者：
Cai, Shubing

Quality of Nursing Homes Among ADRD Residents Newly Admitted From the Community: Does Race Matter?

新入社区的 ADRD 居民的疗养院质量：种族重要吗？