Impact of AD/ADRD on Health-Related Outcomes in a Statewide Population Enrolled in a Publicly-Funded HCBS Waiver Program for Older Adults

AD/ADRD 对参加公共资助的老年人 HCBS 豁免计划的全州人口健康相关结果的影响

• 批准号: 10095054
• 负责人: Richard H Fortinsky
• 金额: $ 227.44万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 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/10095054
• 关键词: Achievement; Acute; Address; Admission activity; Affect; Alzheimer' s disease diagnosis; Alzheimer' s disease related dementia; Assessment tool; Attenuated; Black race; Caring; Client; Cognitive deficits; Communities; Connecticut; Data; Dementia; Elderly; Eligibility Determination; Emergency department visit; Enrollment; Ethnic Origin; Ethnic group; Funding; Goals; Growth; Health; Health Services; Hispanics; Home Nursing Care; Home environment; Hospitalization; Impaired cognition; Independent Living; Individual; Interview; Journals; Knowledge; Link; Medicaid; Medicaid services; Medicare/Medicaid; Nursing Homes; Older Population; Outcome; Participant; Peer Review; Persons; Policies; Population; Population Heterogeneity; Population Programs; Population Study; Professional Organizations; Publications; Race; Reporting; Retrospective cohort; Risk; Sampling; Services; Severities; Support System; adverse outcome; base; community based service; dementia care; ethnic diversity; experience; health disparity; health service use; improved; informal caregiver; informal support; interest; meetings; patient home care; person centered; programs; racial diversity; scientific organization; service programs; success; waiver

Project Summary Many states are aggressively reforming their long-term services and supports systems by constraining the growth of nursing homes and expanding availability of home and community-based services (HCBS) through Medicaid waiver programs, which intend to maximize independent living for individuals at risk for nursing home care. Eligibility criteria for Medicaid HCBS waiver programs include financial and health-related factors, the latter which typically include functional and cognitive deficits. Medicaid HCBS waiver program populations of older adults across the states include individuals living at home with and without diagnosed Alzheimer's disease and related dementia (ADRD) as well as with a wide range of cognitive deficits even without a diagnosis of ADRD. ADRD is associated with many adverse health-related outcomes in population-based studies of community-dwelling older adults; however, whether and how ADRD and cognitive impairment severity are associated with adverse outcomes among older adults receiving services from Medicaid HCBS waiver programs is unknown. Little is known about the strength of informal caregiver support systems and their effects on adverse outcomes for older adults with and without dementia in HCBS programs. Success in meeting self-identified goals of care among older Medicaid HCBS waiver participants, and barriers to achieving these goals, have also not been explored in the context of having ADRD. Moreover, how race and ethnicity might modify effects in associations between ADRD, informal support systems, and health outcomes is unknown in this population. We propose to address these important and interrelated knowledge gaps guided by person-centeredness and health disparities conceptual frameworks. We will study a statewide population enrolled in Connecticut's Home Care Program for Elders (CHCPE), the Medicaid HCBS waiver program for older adults. CHCPE has a racially and ethnically diverse population, and State Medicaid policy decision-makers have expressed strong interest in improving dementia care for CHCPE participants. In Connecticut, a person-centered approach to care planning and implementation guides all Medicaid HCBS waiver program policies and practices. Specific aims guiding this study are to, in the CHCPE participant population: Aim 1: Determine how living with ADRD is associated with health service utilization, including emergency department visits, hospitalizations, and post-acute or long-term admission to nursing homes. Aim 2: Determine whether strength of the informal caregiver support system is associated with utilization of all health services under study, according to ADRD status and racial and ethnic group membership. Aim 3: Determine how living with ADRD, and racial and ethnic group membership, are associated with meeting self-identified goals of care and person-centered outcomes based on their HCBS-related experiences. The study team will disseminate findings to state Medicaid officials and other stakeholders concerned with how best to help CHCPE clients living with ADRD avoid or delay adverse health outcomes and achieve self- identified goals of care. Dissemination activities also will include presentations at annual meetings of relevant national professional and scientific organizations, and publications in relevant peer-reviewed journals.

项目概要 许多州正在积极改革其长期服务和支持系统，限制 疗养院的发展以及家庭和社区服务 (HCBS) 的扩大 医疗补助豁免计划，旨在最大限度地提高有养老院风险的个人的独立生活 关心。医疗补助 HCBS 豁免计划的资格标准包括财务和健康相关因素，后者 这通常包括功能和认知缺陷。医疗补助 HCBS 豁免计划老年人群体 各州的成年人包括患有或未诊断出阿尔茨海默病的在家中的个人，以及 相关痴呆症（ADRD）以及广泛的认知缺陷，即使没有诊断出 ADRD。 在基于人群的研究中，ADRD 与许多不良健康相关结果相关 社区居住的老年人；然而，ADRD 和认知障碍的严重程度是否以及如何影响 与接受 Medicaid HCBS 豁免计划服务的老年人的不良后果相关 未知。人们对非正式护理人员支持系统的力量及其对不利影响的影响知之甚少。 HCBS 计划中患有或不患有痴呆症的老年人的结果。成功实现自我确定的目标 老年医疗补助 HCBS 豁免参与者的护理问题以及实现这些目标的障碍也没有得到解决 在 ADRD 的背景下进行了探索。此外，种族和族裔可能如何改变影响 ADRD、非正式支持系统和健康结果之间的关联在该人群中尚不清楚。 我们建议以人为本来解决这些重要且相互关联的知识差距 和健康差异概念框架。我们将研究在康涅狄格州就读的全州人口 老年人家庭护理计划 (CHCPE)，针对老年人的医疗补助 HCBS 豁免计划。 CHCPE 具有 种族和族裔多样化的人口，以及州医疗补助政策决策者都表达了强烈的 对改善 CHCPE 参与者的痴呆症护理感兴趣。在康涅狄格州，以人为本的护理方法 规划和实施指导所有医疗补助 HCBS 豁免计划政策和实践。 指导本研究的具体目标是，在 CHCPE 参与者人群中： 目标 1：确定 ADRD 生活与医疗服务利用（包括紧急情况）之间的关系 科室就诊、住院治疗以及急性期后或长期入住疗养院。 目标 2：确定非正式护理人员支持系统的强度是否与所有人员的利用率相关 根据 ADRD 状况以及种族和族裔群体成员身份，正在研究卫生服务。 目标 3：确定患有 ADRD 的生活以及种族和族裔群体成员身份与会议之间的关系 根据 HCBS 相关经验自我确定的护理目标和以人为本的结果。 研究小组将向州医疗补助官员和其他相关利益相关者传播研究结果 如何最好地帮助患有 ADRD 的 CHCPE 客户避免或延迟不良健康结果并实现自我 确定的护理目标。传播活动还包括在相关的年会上进行介绍 国家专业和科学组织以及相关同行评审期刊上的出版物。