Person-Reported and Health Care Utilization Outcomes of Home and Community Based Care Recipients With and Without Alzheimer's Disease and its Related Dementias

患有和不患有阿尔茨海默病及其相关痴呆症的家庭和社区护理接受者的个人报告和医疗保健利用结果

• 批准号: 10092440
• 负责人: Eric Jutkowitz
• 金额: $ 211.64万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10092440
• 关键词: Accident and Emergency department; Address; Admission activity; Adult; Affect; Aging; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Behavior; Caregiver support; Caring; Client; Communities; Complex; Data; Dementia; Elderly; Enrollment; Family; Family Caregiver; Funding; Goals; Health; Healthcare; Home Care Services; Home environment; Hospitalization; Infrastructure; Investments; Link; Long-Term Care; Measures; Medicaid; Medicare/Medicaid; Minnesota; Nursing Homes; Outcome; Personal Satisfaction; Persons; Play; Policies; Quality of Care; Recommendation; Recording of previous events; Reporting; Research; Resources; Respondent; Role; Self Care; Services; Surveys; Variant; base; care outcomes; care recipients; care systems; caregiving; community based care; community based service; dementia care; design; disability; experience; health care service utilization; health plan; high risk; improved; improved outcome; innovation; person centered; programs; response; service programs; service providers; service utilization; trend

Project Abstract: More than 5 million Americans live with Alzheimer's disease and related dementias (AD/ADRD), and they receive care from more than 16 million family caregivers. Providing high quality care in the community for people with AD/ADRD is a national priority. Persons with AD/ADRD who are enrolled in Medicaid are eligible to receive home and community-based services (HCBS). HCBS programs vary by state but in general include supportive services (e.g., adult day services and personal care). HCBS are provided by states as an alternative to institutional care and are believed to promote the clients’ independence, health, well-being and help avoid or delay more intensive health care utilization (e.g., nursing home admission). But very little is known about the impact of HCBS for people living with AD/ADRD, including whether person-reported outcomes differ for those with and without AD/ADRD, and whether person- reported HCBS outcomes influence use of health care. To determine whether HCBS improve outcomes that matter to clients, we must first better understand the role of these services from the perspective of care recipients (i.e., person-reported outcomes).Toward that end, we propose to use data from the National Core Indicators-Aging and Disabilities (NCI-AD) Adult Consumer Survey collected between 2017-2020 (n>17,000 HCBS respondents each year), which measure HCBS quality and service outcomes from clients’ perspectives. We also propose to link NCI-AD and Medicare and Medicaid claims for respondents in Minnesota (the only state where this linkage is currently possible) to understand the relationship between person-reported HCBS outcomes and health care use. In response to RFA AG-20-037 we propose the following specific aims: 1. Document trends in the HCBS used and/or desired by clients with and without AD/ADRD. We expect that persons with AD/ADRD will indicate a greater desire to use more HCBS than they currently receive compared to those without AD/ADRD. 2. Determine client and state-level factors that promote person-reported HCBS outcomes among persons with and without AD/ADRD. Hypothesis 2a: Persons with AD/ADRD will have significantly poorer person-reported HCBS outcomes than persons without AD/ADRD. Hypothesis 2b: Greater state investment in HCBS relative to institutional care will be associated with significantly more positive person-reported outcomes for clients both with and without AD/ADRD. 3. Determine the association between health plan-level HCBS person-reported quality and health care use (emergency department, hospitalizations, potentially avoidable hospitalizations, and nursing home admission) for persons with and without AD/ADRD. Clients who receive HCBS from high quality plans (based on person-reported outcomes) will use less health care than their counterparts, and this difference will be larger for clients with AD/ADRD. This study has the potential to yield new evidence both for how HCBS influence important outcomes for persons with AD/ADRD, and for the policy-relevant outcome of health care use.

项目摘要： 超过 500 万美国人患有阿尔茨海默病和相关痴呆症 (AD/ADRD)，他们接受超过 1600 万家庭护理人员的照顾。 为 AD/ADRD 患者提供优质社区护理是国家优先事项。 参加 Medicaid 的 AD/ADRD 有资格接受家庭和社区医疗补助 服务 (HCBS) HCBS 计划因州而异，但一般都包括支持性服务（例如， 成人日间服务和个人护理）由各州提供，作为替代方案。 机构护理，被认为可以促进客户的独立、健康、福祉和 帮助避免或延迟更密集的医疗保健利用（例如入住疗养院）。 关于 HCBS 对 AD/ADRD 患者的影响知之甚少，包括是否 对于患有 AD/ADRD 的人和不患有 AD/ADRD 的人，个人报告的结果有所不同，以及个人是否 报告的 HCBS 结果影响医疗保健的使用，以确定 HCBS 是否有所改善。 对于客户来说重要的结果，我们必须首先更好地理解这些服务的作用 护理接受者的观点（即个人报告的结果）。为此，我们建议 使用国家核心指标 - 老龄化和残疾 (NCI-AD) 成人消费者的数据 2017 年至 2020 年期间收集的调查（每年超过 17,000 名 HCBS 受访者），衡量 我们还建议将 NCI-AD 与 HCBS 质量和服务成果联系起来。 以及明尼苏达州受访者的医疗保险和医疗补助索赔（唯一提供此项服务的州） 目前可以链接）以了解个人报告的 HCBS 之间的关系 针对 RFA AG-20-037，我们提出以下建议。 具体目标： 1. 记录有以下情况的客户使用和/或期望的 HCBS 趋势： 我们预计患有 AD/ADRD 的人会表现出更大的使用意愿。 与没有 AD/ADRD 的人相比，他们目前接受的 HCBS 较多 2. 确定。 促进个人报告的 HCBS 结果的客户和州级因素 患有和不患有 AD/ADRD 的人 假设 2a：患有 AD/ADRD 的人都会有。 与没有 AD/ADRD 的人相比，个人报告的 HCBS 结果明显较差。 假设 2b：相对于机构护理而言，国家对 HCBS 的投资会增加 对于有或没有的客户，个人报告的结果显着更积极 3. 确定健康计划级别的 HCBS 个人报告之间的关联。 质量和医疗保健使用（急诊科、住院治疗、潜在的 对于患有和不患有这种疾病的人来说，可避免的住院治疗和入住疗养院） 从高质量计划中获得 HCBS 的客户（基于个人报告） 结果）将比他们的盟友使用更少的医疗保健，并且这种差异对于 这项研究有可能为 HCBS 的作用提供新的证据。 影响 AD/ADRD 患者的重要结果，以及 AD/ADRD 患者的政策相关结果 保健用途。