The Impact of physician and health system factors on the quality of care for persons with Alzheimer's disease and related dementias at the end of life

医生和卫生系统因素对阿尔茨海默病和相关痴呆症患者临终护理质量的影响

• 批准号: 10260421
• 负责人: Yusuke Tsugawa
• 金额: $ 63.97万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10260421
• 关键词: Academic Medical Centers; Address; Admission activity; Advance Care Planning; Affect; Age; Alzheimer' s Disease; Alzheimer' s disease related dementia; Big Data; Caregiver support; Caring; Cessation of life; Characteristics; Clinical; Clinical Research; Data; Data Set; Database Management Systems; Databases; Family; Fellowship; Funding; Geriatrics; Health Services Research; Health system; Hospitals; Incentives; Individual; Intensive Care Units; Interdisciplinary Study; Intervention; Knowledge; Life; Link; Malignant Neoplasms; Measures; Mechanical ventilation; Medicare; Medicare claim; Methods; Palliative Care; Patient-Focused Outcomes; Patients; Performance; Persons; Physicians; Play; Policies; Population; Positioning Attribute; Process; Quality of Care; Quality of life; Research; Research Personnel; Residencies; Role; Sampling; Socioeconomic Status; Structure; Symptoms; Terminally Ill; Testing; Training; Training and Education; Translational Research; United States National Institutes of Health; Variant; aggressive therapy; cognitive ability; dementia care; design; end of life; end of life care; evidence base; experience; financial incentive; hospice environment; improved; innovation; medical specialties; novel strategies; palliative; programs; provider factors; sex; systems research; therapy design

Project Summary Evidence indicates that individuals with Alzheimer's disease and related dementias (ADRD) often receive suboptimal care at the end of life (EOL). Although patient factors (e.g., socioeconomic status, caregiver support) clearly affect the quality of EOL care, studies also demonstrate wide variations in how physicians and health systems treat terminally-ill patients. However, existing studies on the quality of palliative and EOL care have been focused primarily on patients with cancer, and evidence is limited as to the quality of EOL care for persons with ADRD. Indeed, little is known about physician and health system factors that are associated with the quality of palliative and EOL care for persons with ADRD. These knowledge gaps have hindered efforts to develop interventions that can effectively improve the quality of EOL care for persons with ADRD. The proposed R01 will create a comprehensive, multi-level database that includes detailed information about patients, physicians, and health systems, by linking three large, nationally-representative datasets: (1) Medicare claims data (patient factors), (2) Doximity Physician Database (physician factors), and (3) RAND Health System Database (health system factors). In Aim 1, using this innovative database, we will identify physician factors (e.g., age, sex, clinical experience, specialty, residency and fellowship training in geriatrics and/or palliative care) that are associated with the quality of EOL care (defined as (1) the receipt of advance care planning, palliative care, and hospice, (2) aggressiveness of EOL care, and (3) patient outcomes) for persons with ADRD. In Aim 2, we will identify health system factors (e.g., academic medical centers, profit status, size, region, ACO status) associated with the quality of EOL care for persons with ADRD. In Aim 3, focusing on physicians who practice at multiple health systems (about 21% of physicians practice at multiple health systems), we will investigate whether health system factors influence physicians' aggressiveness of EOL care for persons with ADRD. The proposed R01 will provide a unique opportunity to advance the field by better understanding the mechanisms of how physicians and health systems affect the quality of EOL care provided to persons with ADRD, with a special focus on mutable physician factors (e.g., education and training in geriatrics and/or palliative care) and health system factors (e.g., financial incentives) that contribute to the quality of EOL care. This project will provide a strong evidence base for developing interventions (e.g., CME for physicians targeted at palliative and EOL care for persons with ADRD, financial incentives for ACOs), which can effectively improve the quality of care for persons with ADRD at the EOL. The research team consists of multiple NIH-funded researchers with expertise in all relevant fields (health services research using big data, Alzheimer's disease and dementia research, palliative and EOL care research, and health system research) to conduct this innovative research. The proposed study aligns well with the NIA's FOA to address clinical and translational research gaps to improve quality EOL care for people with ADRD and their families.

项目摘要 证据表明，患有阿尔茨海默氏病和相关痴呆症（ADRD）的人经常接受 生命尽头（EOL）的次优护理。尽管患者因素（例如，社会经济状况，照顾者 支持）清楚地影响了EOL护理的质量，研究还表明，医师和 卫生系统治疗最终的患者。但是，现有关于姑息和EOL护理质量的研究 主要专注于癌症患者，证据是EOL护理质量的限制 与Adrd的人。确实，对关联的医师和卫生系统因素知之甚少 ADRD患者的姑息和EOL护理质量。这些知识差距阻碍了 努力开发可以有效地提高ADRD患者的EOL护理质量的干预措施。 拟议的R01将创建一个全面的多级数据库，其中包含有关的详细信息 患者，医师和卫生系统，通过将三个大型的，全国代表性的数据集联系起来：（1） Medicare索赔数据（患者因素），（2）Doximity医师数据库（医师因素）和（3）RAND 卫生系统数据库（卫生系统因素）。在AIM 1中，使用此创新数据库，我们将确定 医师因素（例如，年龄，性别，临床经验，专业，居住和奖学金培训 和/或姑息治疗）与EOL护理质量相关的（定义为（1）收到预付款 护理计划，姑息治疗和临终关怀，（2）EOL护理的侵略性，（3）患者结果） 与Adrd的人。在AIM 2中，我们将确定卫生系统因素（例如，学术医疗中心，利润 状态，大小，区域，ACO状态）与ADRD患者的EOL护理质量相关。在AIM 3中， 专注于在多个卫生系统中练习的医生（大约21％的医生多次练习 卫生系统），我们将调查卫生系统因素是否影响医师对 EOL护理ADRD的人。拟议的R01将提供一个独特的机会来推进该领域 更好地了解医师和卫生系统如何影响EOL护理质量的机制 提供给ADRD的人，特别关注可变的医师因素（例如，教育和培训 在老年医学和/或姑息治疗中）和卫生系统因素（例如，经济激励措施） EOL护理的质量。该项目将为开发干预措施提供强大的证据基础（例如，CME 医生针对ADRD的人的姑息和EOL护理，对ACOS的经济激励措施） 可以有效地提高EOL ADRD人员的护理质量。研究小组包括 NIH资助的多个具有专业知识的研究人员（使用大数据的卫生服务研究， 阿尔茨海默氏病和痴呆症研究，姑息和EOL护理研究以及卫生系统研究） 进行这项创新的研究。拟议的研究与NIA的FOA很好地对齐，以解决临床和 转化研究差距，以改善ADRD及其家人的质量EOL护理。