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

基本信息

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
项目类别：
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

项目摘要

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病，预计这一数字将接近到 2050 年，这一数字将增加两倍。虽然《解决阿尔茨海默病和相关痴呆症国家计划》旨在协调联邦、州和地方的努力来应对这一日益严峻的挑战，它明确指出“这是一个国家计划而不是联邦计划”，由各个州决定如何最好地照顾这些患者由于随着年龄相关性痴呆的进展，认知和功能发生变化，他们的照顾者。这些患者及其护理人员的需求远远超出了医疗保健的范围，需要来自不同方面的响应然而，社区居住的年龄相关性痴呆患者最容易获得的护理是直接的。此外，随着患者指导自己护理的能力下降，为他们提供的医疗保健也随之下降。可能是由护理人员的需求和偏好驱动的，然后这些患者会经历：支离破碎。医疗护理，多个门诊提供者之间协调不力；可能可以预防的住院治疗；尽管有大量证据表明存在危害，但仍过度使用抗精神病药物，因为这种药物的国家主导性质。国家计划中，至关重要的是为各州提供这种不适当护理的关键预测因素，以帮助指导他们我们将使用国家医疗保险数据、对患有痴呆症的老年人及其护理人员进行的全国调查，以及一个由研究人员和国家政策专家组成的专家小组，以完成以下目标：（1）确定与向社区提供的潜在不适当护理相关的患者和社区因素为患有与年龄相关的痴呆症的成年人提供住房，并建立准确的国家和州级估计我们将使用 Medicare 20% 横截面样本来确定所有 50 名患者的以下使用情况。指出：a) 潜在可预防的住院治疗；b) 分散的门诊护理；以及 c) 抗精神病药物的使用。确定额外患者临床、功能、护理人员和护理的贡献与位置影响相关的潜在不适当护理的特征，我们将使用国家标准。健康和老龄化趋势研究、全国护理人员调查和地区卫生资源文件以确定与潜在不当行为相关的患者、护理人员和地区医疗保健系统特征痴呆症患者的医疗护理 (3) 制定基于证据的痴呆症政策制定指南。我们将用它来采访州老龄政策官员和痴呆症研究人员专家小组。州老龄化政策专家将应用我们的目标 1 和目标 2 研究结果来制定基于证据的政策框架，特别强调高危人群，我们将用它来指导访谈我们工作的影响将是： 1) 确定患者、护理人员和地区。导致年龄相关性痴呆患者医疗护理可能不适当的因素2) 提供衡量未来系统级干预措施的基线；以及 3) 制定框架各州制定基于证据的痴呆症护理州计划。

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）

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

美国临终关怀受益人抗精神病药物和苯二氮卓类药物处方的各州差异。

DOI：
发表时间：
2022-12
期刊：
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.

2014-2016 年美国临终关怀受益人精神药物和阿片类药物处方的流行率。

DOI：
发表时间：
2021
期刊：
影响因子：
6.3
作者：
Gerlach, Lauren B;Kales, Helen C;Kim, Hyungjin Myra;Zhang, Lan;Strominger, Julie;Covinsky, Kenneth;Teno, Joan;Bynum, Julie P W;Maust, Donovan T
通讯作者：
Maust, Donovan T

Variation in Benzodiazepine and Antipsychotic Prescribing Among Hospice Agencies.

临终关怀机构之间苯二氮卓类药物和抗精神病药物处方的差异。

DOI：
发表时间：
2022-11
期刊：
影响因子：
5.7
作者：
Gerlach, Lauren B;Zhang, Lan;Strominger, Julie;Kim, Hyungjin Myra;Teno, Joan;Bynum, Julie P W;Maust, Donovan T
通讯作者：
Maust, Donovan T

Caregiver support and place of death among older adults.

老年人的护理人员支持和死亡地点。