Patient, Caregiver, and Regional Drivers of Potentially Inappropriate Medical Care for Dementia: Building the Foundation for State Dementia Policy

痴呆症医疗护理可能不适当的患者、护理人员和地区驱动因素：为国家痴呆症政策奠定基础

• 批准号: 10090545
• 负责人: DONOVAN T MAUST
• 金额: $ 40.95万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10090545
• 关键词: Academy; Address; Adult; African American; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; Ambulatory Care; Antipsychotic Agents; Area; Behavioral; Caregivers; Caring; Characteristics; Clinical; Cognitive; Communities; Companions; County; Data; Dementia; Elderly; Family; Foundations; Future; Health; Health Policy; Health Resources; Health Services; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Hour; Individual; Intervention; Interview; Investigation; Left; Link; Location; Maps; Measures; Medical; Medicare; Medicare claim; Mental Health Services; Nature; Outcome; Outpatients; Patient Care; Patients; Persons; Pharmaceutical Preparations; Policies; Policy Making; Population; Provider; Quality of Care; Reporting; Research Personnel; Risk; Sampling; Spouse Caregiver; Surveys; System; Time; United States; Visit; Vulnerable Populations; Work; age related; care providers; caregiving; dementia care; evidence base; experience; falls; family caregiving; male; mortality; multilevel analysis; preference; residence; response; trend

4.7 million people in the United States had Alzheimer's disease in 2010, a number that is projected to nearly triple by 2050. While the National Plan to Address Alzheimer's Disease and Related Dementias is an effort to coordinate federal, state, and local efforts to confront this growing challenge, it explicitly states “this is a national plan and not a federal plan”, with individual states left to determine how to best care for these patients and their caregivers. Because of cognitive and functional changes as age-related dementia progresses, the needs of these patients and their caregivers extend far beyond healthcare, requiring a diverse response from states. However, the care most accessible to community-dwelling patients with age-related dementia is direct medical care. In addition, as a patient's ability to direct their own care declines, the healthcare provided to them may be driven by the needs and preferences of the caregiver. These patients then experience: fragmented medical care, poorly-coordinated across multiple outpatient providers; potentially preventable hospitalization; and overuse of antipsychotics despite extensive evidence of harms. Because of the state-led nature of the National Plan, it is critical to provide states with key predictors of this inappropriate care to help guide their policy. We will use national Medicare data, a national survey of older adults with dementia and their caregivers, and an Expert Panel of researchers and state policy experts to complete the following aims: (1) Identify patient and community factors associated with potentially inappropriate care delivered to community- dwelling adults with age-related dementia and establish accurate national and state-level estimates of this care. We will use a cross-sectional Medicare 20% sample to determine use of the following for all 50 states: a) potentially-preventable hospitalization; b) fragmented outpatient care; and c) antipsychotic use. (2) Determine the contribution of additional patient clinical, functional, caregiver, and caregiving characteristics to potentially inappropriate care relative to the effect of location. We will use the National Health and Aging Trends Study, National Survey of Caregivers, and Area Health Resource File to determine the patient, caregiver, and regional healthcare system characteristics associated with potentially inappropriate medical care for persons with dementia. (3) Develop an evidence-based policy making guide for dementia that we will use to interview state aging policy officials. An Expert Panel of dementia researchers and state aging policy experts will apply our Aim 1 and Aim 2 findings to develop an evidence-based policymaking framework with particular emphasis on populations most at risk, which we will use to guide interviews with state aging policy officials. The impact of our work will be to: 1) identify the patient, caregiver, and regional factors that contribute to potentially inappropriate medical care for patients with age-related dementia; 2) provide a baseline against which to measure future system-level interventions; and 3) develop a framework for states to develop evidence-based dementia care state plans.

2010年，美国有470万人患有阿尔茨海默氏病，这一数字几乎被预计 到2050年，三倍。尽管解决阿尔茨海默氏病和相关痴呆症的国家计划是努力 协调联邦，州和地方努力以面对这一日益严重的挑战，它明确指出：“这是一个 国家计划，而不是联邦计划”，单个州剩下的国家可以确定如何为这些患者提供最好的护理 和他们的照顾者。由于随着年龄相关的痴呆的发展，认知和功能变化， 这些患者及其护理人员的需求远远超出了医疗保健，需要潜水员的反应 国家。但是，与年龄有关的痴呆症患者最容易获得的护理是直接的 医疗。此外，随着患者指导自己的护理的能力，提供给他们的医疗保健 可以由照料者的需求和偏好驱动。然后这些患者经历：分散 医疗保健，在多个门诊提供者中协调不良；可能预防的住院； 并过度使用抗精神病药目的地广泛的危害证据。由于国家主导的本质 国家计划，至关重要的是为各州提供这种不适当护理的关键预测指标，以帮助他们指导他们 政策。我们将使用国家医疗保险数据，这是一项全国性的痴呆症老年人及其护理人员的调查， 以及研究人员和国家政策专家的专家小组完成以下目的：（1）确定 患者和社区因素与可能不适当的护理相关的社区 - 居住成年人患有与年龄有关的痴呆症，并确立了准确的国家和州级估计 这个护理。我们将使用横截面Medicare 20％样本来确定所有50个 国家：a）潜在可预防的住院； b）分散的门诊护理； c）抗精神病药物。 （2） 确定其他患者临床，功能，护理人员和护理人员的贡献 相对于位置效果，潜在不当护理的特征。我们将使用国家 健康和老龄化趋势研究，国家护理人员调查以及地区健康资源文件以确定 患者，护理人员和区域医疗保健系统特征与潜在不适当 痴呆症患者的医疗服务。 （3）制定基于证据的痴呆政策制定指南 我们将用来采访国家老化政策官员。痴呆研究人员和 国家老化政策专家将应用我们的目标1和目标2调查结果以制定循证决策 框架特别强调人口最有风险的框架，我们将用来指导采访 国家老化政策官员。我们工作的影响将是：1）确定患者，护理人员和地区 与年龄相关痴呆患者有可能导致不适当医疗的因素； 2） 提供一个基线来衡量未来的系统级干预措施； 3）开发一个框架 国家制定基于证据的痴呆症护理状态计划。

项目成果

Nursing Home Characteristics Associated with High and Low Levels of Antipsychotic, Benzodiazepine, and Opioid Prescribing to Residents with Alzheimer's Disease and Related Dementias: A Cross-Sectional Analysis.

• DOI: 10.1016/j.jamda.2022.05.025
• 发表时间: 2022-11
• 期刊: JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
• 影响因子: 7.6
• 作者: Candon, Molly;Strominger, Julie;Gotlieb, Evelyn;Maust, Donovan T.
• 通讯作者: Maust, Donovan T.

State variation in antipsychotic and benzodiazepine prescribing among hospice beneficiaries in the United States.

• DOI: 10.1111/jgs.17992
• 发表时间: 2022-12
• 期刊: JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
• 影响因子: 6.3
• 作者: Gerlach, Lauren B.;Zhang, Lan;Strominger, Julie;Teno, Joan;Bynum, Julie P. W.;Maust, Donovan T.
• 通讯作者: Maust, Donovan T.

Prevalence of psychotropic and opioid prescribing among hospice beneficiaries in the United States, 2014-2016.

• DOI: 10.1111/jgs.17085
• 发表时间: 2021-06
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Gerlach LB;Kales HC;Kim HM;Zhang L;Strominger J;Covinsky K;Teno J;Bynum JPW;Maust DT
• 通讯作者: Maust DT

Caregiver support and place of death among older adults.

• DOI: 10.1111/jgs.17055
• 发表时间: 2021-05
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Lei L;Gerlach LB;Powell VD;Maust DT
• 通讯作者: Maust DT

Reply to: Comment on: Antiepileptic prescribing to persons living with dementia residing in nursing homes: A tale of two indications.

回复：评论：为居住在疗养院的痴呆症患者开抗癫痫药：两个适应症的故事。

• DOI: 10.1111/jgs.18513
• 发表时间: 2023
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Candon,Molly;Strominger,Julie;Gerlach,LaurenB;Maust,DonovanT
• 通讯作者: Maust,DonovanT