Visiting Nurse Service Of New York

EARLY HEAD START PROGRAM.

SANDY DISASTER RELIEF

GENDER AFFIRMATION, QUALITY OF LIFE, AND ACCESS TO CARE: A MIXED-METHOD LONGITUDINAL INVESTIGATION - PROJECT SUMMARY/ABSTRACT GENDER MINORITIES (GM) HAVE GAINED GREATER VISIBILITY IN U.S. SOCIETY IN RECENT YEARS. HOWEVER, THE PHYSICAL AND MENTAL HEALTH OF GM INDIVIDUALS REMAINS A CRITICAL PUBLIC HEALTH ISSUE. GM FACE PERSISTENT STIGMA, DISCRIMINATION, AND BARRIERS TO SERVICES THAT AFFECT THEIR HEALTH AND WELLBEING OVER THE LIFE COURSE. GENDER AFFIRMATION IS A PROCESS OF RECOGNIZING A PERSON’S GENDER IDENTITY AND EXPRESSION, WHICH MAY INCLUDE EMOTIONAL SUPPORT AS WELL AS SOCIAL AND MEDICAL INTERVENTIONS; IT HAS BEEN ASSOCIATED WITH MENTAL HEALTH AND WELLBEING. UNMET NEEDS FOR GENDER AFFIRMATION HAVE BEEN LINKED TO GREATER RISK BEHAVIOR AND POORER SELF-CARE AMONG GM, PARTICULARLY RELATED TO HIV RISK AND TREATMENT. CLINICIANS WHO ARE SPECIALLY TRAINED IN PROVIDING GENDER-AFFIRMING SERVICES MAY BE UNIQUELY POSITIONED TO SUPPORT THE EMOTIONAL NEEDS OF GM INDIVIDUALS, WITH THE POTENTIAL TO HAVE A LONG-TERM IMPACT ON A PERSON’S TRUST AND COMFORT IN INTERACTING WITH HEALTHCARE PROVIDERS, ENGAGEMENT AND RETENTION IN CARE, AND SELF-CARE BEHAVIORS THAT INFLUENCE ONE’S HEALTH TRAJECTORY OVER THE LIFE COURSE. THERE IS A DEARTH OF EVIDENCE ON THE HEALTHCARE NEEDS OF GM INDIVIDUALS AFTER SURGERY, THEIR PSYCHOSOCIAL ADJUSTMENT DURING THIS PHASE OF THEIR IDENTITY DEVELOPMENT, THEIR QUALITY OF LIFE, AND LONG-TERM PHYSICAL AND EMOTIONAL WELLBEING. THE GOAL OF THIS PROSPECTIVE, MIXED METHOD, LONGITUDINAL COHORT STUDY IS TO BUILD A RICH EVIDENCE BASE ON GM IDENTITY DEVELOPMENT AFTER GENDER-AFFIRMING SURGERY AND THE LONG-TERM HEALTHCARE NEEDS OF GM INDIVIDUALS, EXAMINING CHANGES IN MULTIPLE DOMAINS OF QUALITY OF LIFE AND THEIR RELATIONSHIPS WITH HEALTHCARE PROVIDERS. USING A COMBINATION OF QUANTITATIVE AND QUALITATIVE METHODS, OUR SPECIFIC AIMS ARE TO: 1. DOCUMENT CHANGES OVER TIME IN GM INDIVIDUALS’ (N = 300 RECRUITED FROM A GENDER-AFFIRMING, POST-SURGICAL HOME HEALTHCARE PROGRAM) PSYCHOSOCIAL DEVELOPMENT AFTER SURGERY, INCLUDING SUCH DOMAINS AS (I) GENDER AND SEXUAL IDENTITY DEVELOPMENT, (II) INTIMACY AND RELATIONSHIPS, (III) SOCIAL AND COMMUNITY SUPPORT, (IV) EMPLOYMENT AND FINANCIAL WELLBEING, AND (V) ENVIRONMENTAL MASTERY AND PURPOSE IN LIFE. 2. EXAMINE CHANGES IN GM INDIVIDUALS’ HEALTH-RELATED QUALITY OF LIFE AFTER SURGERY, INCLUDING SUCH DOMAINS AS (I) PHYSICAL HEALTH, (II) MENTAL HEALTH AND SOCIAL WELLBEING, (III) SEXUAL FUNCTION, SATISFACTION AND HEALTH, (IV) HEALTH BEHAVIORS AND SELF-CARE, AND (V) ENGAGEMENT AND RETENTION IN HEALTHCARE AND RELATIONSHIPS WITH HEALTHCARE PROVIDERS. 3. IDENTIFY BARRIERS AND FACILITATORS TO GM INDIVIDUALS’ ENGAGEMENT WITH THEIR SELF-CARE AND ENGAGEMENT AND RETENTION IN HOME AND SUBSEQUENT HEALTHCARE FOR BOTH GENDER-RELATED AND OTHER HEALTH CONCERNS. THE STUDY WILL ADDRESS A SIGNIFICANT GAP IN THE CURRENT EVIDENCE ON BEST PRACTICES TO SUPPORT GM INDIVIDUALS DURING A PIVOTAL LIFE COURSE TRANSITION, WITH THE POTENTIAL TO IMPROVE THEIR ENGAGEMENT IN CARE AND MITIGATE THE PERVASIVE DISPARITIES IN HEALTHCARE ACCESS, OUTCOMES, AND QUALITY OF LIFE AFFECTING THIS POPULATION.

ENHANCING MENTAL HEALTH AND SUBSTANCE USE SERVICES FOR THE DIVERSE POPULATION OF YOUTH, FAMILIES AND RESIDENTS OF THE SOUTH BRONX. - PROJECT NAME: ENHANCING MENTAL HEALTH AND SUBSTANCE USE SERVICES FOR THE DIVERSE POPULATION OF YOUTH, FAMILIES AND RESIDENTS OF THE SOUTH BRONX. SUMMARY: THIS PROJECT AIMS TO ADDRESS THE PRESSING AND UNMET MENTAL HEALTH AND SUBSTANCE USE NEEDS FACED BY THE DIVERSE POPULATION RESIDING IN THE SOUTH BRONX. THE TARGET POPULATION INCLUDES RESIDENTS OF MOTT HAVEN, MORRISANIA, HUNTS POINT, HIGHBRIDGE, EAST TREMONT, AND MELROSE. THESE NEIGHBORHOODS EXHIBIT SOCIOECONOMIC DISPARITIES, WITH A HIGH PERCENTAGE OF HISPANIC RESIDENTS AND LIMITED ACCESS TO QUALITY HEALTHCARE. THE PROJECT'S GOALS INCLUDE IMPROVING ACCESS TO COMPREHENSIVE MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES, REDUCING BEHAVIORAL CRISES, AND ENHANCING OVERALL HEALTH OUTCOMES. THROUGHOUT THE PROJECT'S FOUR-YEAR DURATION, IT IS ANTICIPATED TO SERVE 1,484 INDIVIDUALS, WITH AN EQUAL DISTRIBUTION BETWEEN CHILDREN (AGES 5-18) AND ADULTS (AGES 19 AND OLDER). THE PROJECTED NUMBER OF UNDUPLICATED INDIVIDUALS TO BE SERVED ANNUALLY IS AS FOLLOWS: YEAR 1: 275, YEAR 2: 342, YEAR 3: 415, YEAR 4: 452. STRATEGIES AND INTERVENTIONS: THE PROJECT WILL IMPLEMENT A RANGE OF CORE SERVICES, SUCH AS CRISIS MENTAL HEALTH SERVICES, EARLY INTERVENTION/PREVENTION, CRISIS RESPONSE SERVICES, STABILIZATION SERVICES, SCREENING, ASSESSMENT, DIAGNOSIS, PATIENT-CENTERED TREATMENT PLANNING, OUTPATIENT MENTAL HEALTH SERVICES, TARGETED CASE MANAGEMENT, SERVICE REFERRAL AND LINKAGE, PSYCHIATRIC REHABILITATION SERVICES, INTENSIVE COMMUNITY-BASED MENTAL HEALTH CARE FOR ARMED FORCES AND VETERANS, AND SUBSTANCE USE SERVICES. THE SERVICE DELIVERY WILL BE TAILORED TO MEET THE SPECIFIC NEEDS OF THE POPULATION, TAKING INTO ACCOUNT CULTURAL AND LINGUISTIC CONSIDERATIONS AND ACCESS TO CARE. PROJECT GOALS AND MEASURABLE OBJECTIVES: BECOME FULLY COMPLIANT WITH CCBHC REQUIREMENTS BY THE END OF YEAR 1. OBJECTIVES: (1) IMPLEMENT AT LEAST 5 OF 9 CORE SERVICES BY MARCH 2024 AND COMPLETE ALL CORE SERVICES BY SEPTEMBER 2024. (2) ESTABLISH A ROBUST DATA INFRASTRUCTURE INTEGRATED WITH ELECTRONIC MEDICAL RECORDS (EMR) FOR EFFICIENT DATA COLLECTION, ANALYSIS, AND UTILIZATION. (3) MAINTAIN ADHERENCE TO CERTIFICATION CRITERIA FOR ENHANCED MEDICAID REIMBURSEMENT. INCREASE EQUITABLE ACCESS TO COMPREHENSIVE MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES FOR YOUTH, FAMILIES, AND ADULTS IN THE BRONX. OBJECTIVES: (1) PROVIDE SOCIAL DETERMINANTS OF HEALTH (SDOH) ASSESSMENTS TO 100% OF CCBHC PATIENTS. (2) OFFER TARGETED CASE MANAGEMENT SERVICES TO 100% OF CCBHC PATIENTS. (3) FACILITATE WARM HAND-OFFS AND CARE COORDINATION WITH LOCAL HEALTH, SOCIAL, AND HUMAN SERVICE AGENCIES. (4) ENGAGE 100% OF CCBHC PATIENTS IN PEER SUPPORT SERVICES. (5) ENHANCE CULTURAL RESPONSIVENESS THROUGH STAFF TRAININGS. (6) COLLABORATE WITH LOCAL DEPARTMENT OF VETERANS AFFAIRS FACILITIES TO BETTER SERVE VETERANS AND THEIR FAMILIES. (7) ENROLL ELIGIBLE PATIENTS WITH LAPSED HEALTH HOME ELIGIBILITY IN THE VNS HEALTH BEHAVIORAL HEALTH CCBHC. DECREASE THE RISK AND OCCURRENCE OF BEHAVIORAL CRISIS EVENTS AMONG THE POPULATION SERVED. OBJECTIVES: (1) CONDUCT SUBSTANCE USE DISORDER SCREENING FOR 100% OF CCBHC PATIENTS. (2) ENSURE ENROLLMENT OF CCBHC PATIENTS WITH SUBSTANCE USE DISORDER IN TREATMENT. (3) PROVIDE SUICIDE RISK ASSESSMENTS TO 100% OF CCBHC PATIENTS. (4) REDUCE THE RISK OF SUICIDE BY 75% USING THE ZERO SUICIDE MODEL. (5) DELIVER MEDICATION ASSISTED TREATMENT TO 100% OF CCBHC PATIENTS IN NEED. (6) ESTABLISH ROBUST CARE COORDINATION WITH EXTERNAL AGENCIES FOR SEAMLESS TRANSITION AND INTEGRATION OF CARE. IMPROVE OVERALL HEALTH OUTCOMES FOR YOUTH, FAMILIES, AND ADULTS IN THE BRONX. OBJECTIVES (1) CONDUCT PRIMARY CARE SCREENINGS AND HEALTH MONITORING FOR 100% OF CCBHC PATIENTS. (2) SCREEN PATIENTS FOR TOBACCO/ELECTRONIC CIGARETTE USE AND ENROLL 80% OF CCBHC PATIENTS IN CESSATION INTERVENTION.

HEAD START PROGRAM

HOMECARE-CONCERN: BUILDING RISK MODELS FOR PREVENTABLE HOSPITALIZATIONS AND EMERGENCY DEPARTMENT VISITS IN HOMECARE

TREATING PAIN TO REDUCE DISABILITY AMONG OLDER HOME HEALTH PATIENTS

TECHNICAL ASSISTANCE PROVIDER AND EVALUATOR FOR THE COMMUNITY INNOVATIONS IN AGING IN PLACE (CIAIP) GRANTEES

IMPROVING MEDICATION MANAGEMENT PRACTICES AND CARE TRANSITIONS THROUGH TECHNOLOGY

EARLY HEAD START

COMPARATIVE EFFECTIVENESS OF INTENSIVE HOME HEALTH AND MD VISITS IN HEART FAILURE

HOME-BASED BP INTERVENTIONS FOR AFRICAN AMERICANS

A LONGITUDINAL NETWORK STUDY OF ALZHEIMER'S AND DEMENTIA CARE IN RELATION TO DISPARITIES IN ACCESS AND OUTCOMES

NURSE EDUCATION PRACTICE, QUALITY AND RETENTION

BUILT ENVIRONMENT AND HEALTH CARE USE: DISPARITIES AMONG CHRONICALLY ILL ELDERS

COMPREHENSIVE GERIATRIC EDUCATION PROGRAM

IMPROVING SELF-CARE OF CAREGIVERS OF ADULTS IN HOMECARE WITH HEART FAILURE AND COGNITIVE IMPAIRMENT - COGNITIVE IMPAIRMENT (CI) HAS BEEN REPORTED TO BE AS HIGH AS 78% IN OLDER ADULTS WITH HEART FAILURE (HF). PATIENTS WITH BOTH HF AND CI ARE RARELY ABLE TO MANAGE WITHOUT A CAREGIVER. THE DEMANDS OF CAREGIVING FOR SOMEONE WITH HF/CI ARE HIGH AND CAUSE STRESS IN CAREGIVERS AND STRAIN IN THE RELATIONSHIP, WHICH LEADS TO NEGATIVE SOCIAL EXCHANGES, POOR COPING, AND LOWER MENTAL HEALTH IN CAREGIVERS. ANXIETY, DEPRESSION, AND SOMATIC SYMPTOMS ARE COMMON IN PATIENTS WITH HF AND RELATIONSHIP STRAIN CAN MAKE THESE SYMPTOMS WORSE. SUPPORT INTERVENTIONS CAN DECREASE STRESS IN CAREGIVERS. WE DEMONSTRATED EFFICACY OF A 10-SESSION VIRTUAL HEALTH COACHING INTERVENTION, VIRTUAL CAREGIVER COACH FOR YOU (VICCY), FOR CAREGIVERS OF ADULTS WITH HF (R01-NR-018196) THAT FOCUSED ON INCREASING CAREGIVER SELF-CARE. VICCY WAS SUCCESSFUL IN IMPROVING SELF-CARE AND DECREASING STRESS IN A SAMPLE OF 250 CAREGIVERS RECRUITED FROM A LARGE URBAN REGIONAL REFERRAL CENTER FOR ADVANCED HF CARE. HOWEVER, THE CAREGIVERS WERE PRIMARILY WHITE (62.2%) WOMEN (85.2%) WITH ADEQUATE FINANCIAL RESOURCES (82.3%) AND THE PATIENTS WERE PRINCIPALLY MEN WITH FEW COMORBID CONDITIONS; ONLY 10% HAD MILD CI. NOW THAT WE HAVE SHOWN EFFICACY IN THIS FIRST STAGE II TRIAL, WE AIM TO EXPAND TESTING TO A BROADER, MORE CHALLENGING POPULATION OF UNDERSERVED CAREGIVERS OF PATIENTS WITH HF/CI. IN THE PROPOSED TRIAL WE WILL ENROLL 254 CAREGIVERS SUPPORTING PATIENTS WITH HF/CI FROM HOME HEALTH CARE (HHC). WE WILL ALSO ENROLL AT LEAST 60 PATIENTS WITH HF AND MILD OR MODERATE CI (30/STUDY ARM). IN NEW YORK CITY, WHERE THIS STUDY WILL BE CONDUCTED, MANY OF THE PATIENTS REFERRED TO HHC ARE OLDER ADULTS FROM WIDE-RANGING POPULATIONS WITH A VARIETY OF CHRONIC CONDITIONS INCLUDING HF/CI. WE WILL ENROLL CAREGIVERS OF OLDER HHC PATIENTS WITH HF/CI WITH POOR SELF-CARE AND POOR MENTAL HEALTH, PURPOSEFULLY SEEKING A VARIED SAMPLE. USING A STAGE II RANDOMIZED CONTROLLED TRIAL (RCT) DESIGN, WE WILL RANDOMIZE CAREGIVERS 1:1 TO VICCY OR A USUAL CARE (UC) CONTROL GROUP. AT BASELINE, 3, 6, AND 12 MONTHS, WE WILL COLLECT SELF-REPORTED DATA FROM CAREGIVERS AND PATIENTS TO ASSESS INTERVENTION EFFICACY AND SUSTAINABILITY USING INTENT-TO-TREAT ANALYSIS. HAVING DEMONSTRATED THAT VICCY IMPROVES MECHANISTIC OUTCOMES AT 6-MONTHS IN THE FIRST RCT, HERE WE WILL FOCUS ON MENTAL HEALTH AS THE PRIMARY OUTCOME IN CAREGIVERS. ENROLLING PATIENTS WILL ALLOW US TO EXPLORE WHETHER AN INTERVENTION FOR CAREGIVERS CAN IMPROVE OUTCOMES IN PATIENTS. MECHANISTIC ANALYSES WILL BE USED TO EXPLORE WHICH KINDS OF CHANGES IN CAREGIVERS TRANSLATE INTO CHANGES IN PATIENTS. SPECIFIC AIMS ARE TO TEST THE EFFICACY OF VICCY VS. UC IN IMPROVING OUTCOMES OF CAREGIVERS OF HHC PATIENTS WITH HF/CI, EXPLORE THE EFFECT OF VICCY ON OUTCOMES IN HHC PATIENTS WITH HF/CI, AND DESCRIBE THE MECHANISMS BY WHICH OUTCOMES ARE ACHIEVED. THIS APPLICATION ALIGNS WITH NIA’S NOTICE OF SPECIAL INTEREST ON BEHAVIORAL AND SOCIAL SCIENCE PRIORITY AREAS IN DEMENTIA CARE PARTNER/CAREGIVER RESEARCH (NOT-AG-21-047). IF VICCY IS EFFICACIOUS IN CAREGIVERS ASSISTING HHC PATIENTS WITH HF/CI, THIS WILL BE FURTHER EVIDENCE THAT VICCY MAY BE ABLE TO ADDRESS A NEED FOR SUPPORT FOR MILLIONS OF CAREGIVERS WORLDWIDE.

COMPARATIVE EFFECTIVENESS OF HOME HEALTH THERAPIES AFTER JOINT REPLACEMENT

SUPPORTING DEMENTIA CAREGIVERS DURING MEDICARE HOME HEALTH: DEVELOPING THE DECLARE NEEDS ASSESSMENT INTERVENTION - PROJECT SUMMARY/ABSTRACT THROUGH MEDICARE-FUNDED SKILLED HOME HEALTH CARE (HH), COMMUNITY-LIVING OLDER ADULTS MAY RECEIVE SKILLED NURSING, THERAPY, AND AIDE SERVICES IN THEIR HOME. HH IS A CRUCIAL SOURCE OF CARE FOR OLDER ADULTS WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS (ADRD); 31% OF THE 3.4 MILLION MEDICARE BENEFICIARIES WHO ACCESS HH EACH YEAR HAVE ADRD. THE MAJORITY (92%) OF HH PATIENTS WITH ADRD REQUIRE HELP FROM FAMILY AND UNPAID CAREGIVERS TO IMPLEMENT THE HH PLAN OF CARE. YET, CAREGIVER NEEDS ARE NOT SYSTEMATICALLY ASSESSED DURING HH AND THEY FREQUENTLY FACE UNMET TRAINING/SUPPORT NEEDS. UNMET CAREGIVER NEEDS CONTRIBUTE TO INCREASED COSTS, DECREASED PATIENT/FAMILY SATISFACTION, AND HIGHER PATIENT RISK FOR HOSPITALIZATION AND INSTITUTIONALIZATION DURING HH. THE PROPOSED K01 WILL DEVELOP, REFINE, AND PILOT TEST AN ADRD CAREGIVER NEEDS ASSESSMENT INTERVENTION FOR HH: DECLARE (DEMENTIA CAREGIVERS' LINK TO ASSISTANCE AND RESOURCES). DECLARE WILL HARNESS A WEB-BASED SURVEY PLATFORM TO ELICIT INFORMATION FROM ADRD CAREGIVERS ABOUT THEIR AVAILABILITY, CAPABILITIES, AND NEEDS AT THE TIME OF HH ADMISSION. THIS DATA WILL THEN POPULATE IN THE HH PATIENT RECORD ALONG WITH SUGGESTED NEXT STEPS FOR HH STAFF. SPECIFIC AIMS INCLUDE: (1) DEVELOP AN ADRD CAREGIVER SELF-ASSESSMENT INTERVENTION (DECLARE) PROTOTYPE; (2) ITERATIVELY REFINE THE INTERVENTION (DECLARE) IN PARTNERSHIP WITH KEY STAKEHOLDERS; (3) IMPLEMENT AND PILOT TEST DECLARE VIA AN EMBEDDED PRAGMATIC CLINICAL TRIAL, EVALUATING FOR FEASIBILITY, ACCEPTABILITY, AND IMPACT ON HH CARE TEAM/CAREGIVER COMMUNICATION AND SUPPORT. AIMS WILL BE PURSUED IN PARTNERSHIP WITH VISITING NURSE SERVICE OF NEW YOK (VNSNY), THE LARGEST NON-PROFIT HH PROVIDER IN THE NATION. FINDINGS WILL SUPPORT A PLANNED R01 TO TEST DECLARE'S IMPACT ON PATIENT CLINICAL OUTCOMES AND CAREGIVER SELF-EFFICACY AND BURDEN. DR. JULIA BURGDORF, PHD, IS A RESEARCH SCIENTIST AT THE CENTER FOR HOME CARE POLICY & RESEARCH AT VNSNY. SHE IS IDEALLY POSITIONED TO LEAD THE PROPOSED RESEARCH AS AN EXPERT IN FAMILY CAREGIVER INVOLVEMENT IN HH CARE AND AN EMBEDDED RESEARCHER AT VNSNY. HER CAREER GOAL IS TO IMPROVE HOME- AND COMMUNITY-BASED CARE FOR OLDER ADULTS BY DEVELOPING PRAGMATIC CLINICAL INTERVENTIONS THAT FACILITATE PROVIDER-LED ENGAGEMENT AND SUPPORT OF FAMILY CAREGIVERS, WITH A FOCUS ON CAREGIVERS FOR INDIVIDUALS WITH ADRD. TO ACHIEVE THIS GOAL, DR. BURGDORF WILL PURSUE TARGETED MENTORSHIP AND TRAINING IN 5 KEY AREAS DURING THE K01: (1) CONSUMER-FACING TECHNOLOGIES FOR CLINICAL INNOVATION IN HH, (2) HUMAN-CENTERED DESIGN, (3) INTERVENTION EVALUATION AND EMBEDDED PRAGMATIC CLINICAL TRIALS, (4) ADRD RESEARCH, AND (5) INDEPENDENT GRANT WRITING. SHE HAS ASSEMBLED AN INTERDISCIPLINARY MENTORING AND ADVISORY TEAM WHOSE COMPLEMENTARY RESEARCH EXPERTISE AND EXPERIENCE MENTORING EARLY CAREER INVESTIGATORS WILL PROVIDE INVALUABLE SUPPORT AND GUIDANCE, WHILE FOSTERING HER ONGOING COLLABORATIONS WITH ACADEMIC RESEARCH SETTINGS AND A MAJOR LEARNING HEALTH SYSTEM. THIS K01 WOULD PROVIDE DR. BURGDORF WITH THE NECESSARY TIME AND LEARNING EXPERIENCES TO TRANSITION TO AN INDEPENDENT INVESTIGATOR EQUIPPED TO LEAD IMPACTFUL INTERVENTIONAL RESEARCH IMPROVING PROVIDER/CAREGIVER COLLABORATION AND CARE OUTCOMES IN THE HH SETTING.

NURSES' DOCUMENTATION OF PATIENT DIAGNOSES, SYMPTOMS AND INTERVENTIONS FOR HOME CARE PATIENTS WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS: A NATURAL LANGUAGE PROCESSING STUDY

ADDRESSING DISPARITIES IN HEALTHCARE ACCESS AND OUTCOMES AMONG CHRONICALLY ILL OLDER ADULTS: ASSESSING THE FEASIBILITY OF AN AGENT-BASED MODELING APPROACH

INVESTIGATING DISPARITIES IN HOME HEALTH ACCESS AND QUALITY FOR MEDICARE BENEFICIARIES WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS FOLLOWING RECENT PAYMENT SYSTEM REVISIONS - PROJECT SUMMARY OF 5.4 MILLION PERSONS WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS (ADRD) IN THE US, 70% LIVE IN THE COMMUNITY AND ARE AT HIGH RISK FOR UNMET CARE NEEDS. MEDICARE HOME HEALTH (HH) IS A CRUCIAL SOURCE OF CARE FOR COMMUNITY-LIVING OLDER ADULTS WITH ADRD, DELIVERING SKILLED NURSING, THERAPY, AND AIDE SERVICES IN THE PATIENT'S HOME. PATIENTS CAN ENTER HH FOLLOWING AN INPATIENT STAY (POST-ACUTE HH) OR REFERRAL BY A COMMUNITY PHYSICIAN (COMMUNITY-ENTRY HOME HEALTH (CEHH)). NEARLY HALF (44%) OF MEDICARE HH EPISODES ARE CEHH. THOSE WITH ADRD ARE ESPECIALLY LIKELY TO ACCESS CEHH. PRIOR RESEARCH SHOWS THAT 30% OF CEHH PATIENTS HAVE ADRD, COMPARED TO JUST 12% OF POST-ACUTE HH PATIENTS. RECENT CHANGES TO MEDICARE HH REIMBURSEMENT UNDER THE PATIENT-DRIVEN GROUPINGS MODEL (PDGM) ADJUST PAYMENT BY REFERRAL SOURCE; PDGM IS PROJECTED TO REDUCE AVERAGE REIMBURSEMENT FOR CEHH BY 11% WHILE INCREASING AVERAGE REIMBURSEMENT FOR POST-ACUTE HH BY 29% (HOLDING OTHER PATIENT CHARACTERISTICS CONSTANT) AND DOES NOT ADJUST FOR PATIENT ADRD STATUS. THESE CHANGES HAVE PROMPTED CONCERNS THAT PDGM WILL NEGATIVELY IMPACT CEHH PATIENTS, ESPECIALLY THOSE WITH ADRD. THE ONLY EXISTING ANALYSIS OF PDGM'S EFFECTS ON HH UTILIZATION FAILS TO EXAMINE DIFFERENCES BY REFERRAL SOURCE (COMMUNITY VS POST-ACUTE), INVESTIGATE IMPACTS AMONG VULNERABLE BENEFICIARY SUBPOPULATIONS, SUCH AS THOSE WITH ADRD, OR STUDY CHANGES IN PATIENT OUTCOMES. THE GOAL OF THE PROPOSED RESEARCH IS TO ASSESS PDGM'S IMPACT ON CEHH ACCESS, CARE DELIVERY, AND OUTCOMES FOR COMMUNITY-LIVING OLDER ADULTS WITH ADRD. WE WILL LINK MEDICARE CLAIMS, HH ASSESSMENT, AND HH AGENCY DATA, ALONG WITH GEOGRAPHIC DATA FROM THE AMERICAN COMMUNITY SURVEY, FOR A 100% SAMPLE OF MEDICARE BENEFICIARIES FROM 2019-2021. SPECIFIC AIMS ARE: (1) CHARACTERIZE PDGM'S IMPACT ON CEHH ACCESS FOR COMMUNITY-LIVING MEDICARE BENEFICIARIES WITH ADRD, (2) DETERMINE PDGM'S IMPACT ON CEHH CARE DELIVERY (E.G., NUMBER AND TYPE OF VISITS) FOR PATIENTS WITH ADRD, (3) ASSESS PDGM'S ASSOCIATION WITH CEHH OUTCOMES (E.G., HOSPITALIZATION, EMERGENCY DEPARTMENT VISITS) FOR PATIENTS WITH ADRD. IN ALL AIMS, WE WILL ADJUST FOR SOCIAL AND CLINICAL CHARACTERISTICS OF THE OLDER ADULT, AS WELL AS CHARACTERISTICS OF THEIR ZIP CODE AND STATE OF RESIDENCE, AND THE HH AGENCY PROVIDING CARE. PDGM WAS IMPLEMENTED IN 2020, BUT DUE TO SERVICE DISRUPTIONS RELATED TO COVID- 19, WE CONSIDER 2019 AS THE “PRE” PERIOD AND 2021 AS THE “POST” PERIOD (AVAILABLE EVIDENCE SHOWS PATIENT VOLUME AND AVERAGE COMORBIDITY SCORES STABILIZED BY 2021, REFLECTING 2019 LEVELS). THIS RESEARCH IS NEEDED TO ASSESS WHETHER A NEW PAYMENT SYSTEM (PDGM) HAS CONTRIBUTED TO DISPARITIES IN HH ACCESS AND QUALITY FOR THOSE WITH ADRD. FINDINGS WILL PROVIDE THE FIRST EVIDENCE REGARDING PDGM'S IMPACTS ON CEHH CARE FOR THOSE WITH ADRD AND COULD INFORM PAYMENT SYSTEM REVISIONS AIMED AT ENSURING ACCESSIBLE, HIGH-QUALITY HOME-BASED CARE FOR THIS HIGH-NEED SUBPOPULATION. THIS WORK IS ESPECIALLY TIMELY GIVEN THE UPWARD TREND IN HH UTILIZATION AND GROWING NUMBERS OF COMMUNITY-LIVING INDIVIDUALS WITH ADRD.

DEVELOPMENT OF DASHBOARDS TO PROVIDE FEEDBACK TO HOME CARE NURSES

EFFECTS OF FAMILY CAREGIVER AVAILABILITY AND CAPACITY ON HOME HEALTH CARE FOR OLDER ADULTS WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS - PROJECT SUMMARY/ABSTRACT OF AN ESTIMATED 5.4 MILLION OLDER ADULTS WITH ALZHEIMER’S DISEASE AND RELATED DEMENTIAS (ADRD) IN THE US, 67% RESIDE IN THE COMMUNITY WITH UNIQUE AND SIGNIFICANT CARE NEEDS. MEDICARE-FUNDED HOME HEALTH (HH) DELIVERS SKILLED NURSING, THERAPY, AND PERSONAL CARE AIDE SERVICES IN THE PATIENT’S HOME AND IS ONE OF FEW AFFORDABLE AND ACCESSIBLE OPTIONS FOR HOME-BASED CARE AMONG THOSE WITH ADRD. OF THE 3.4 MILLION MEDICARE BENEFICIARIES WHO ACCESS HH EACH YEAR, 31% HAVE ADRD. HH PATIENTS WITH ADRD RECEIVE MORE INTENSIVE CARE, YET ARE MORE LIKELY TO EXPERIENCE ADVERSE OUTCOMES INCLUDING INSTITUTIONALIZATION AND HOSPITALIZATION. THUS, THERE IS CRITICAL NEED TO DEVELOP TAILORED HH INTERVENTIONS TO IMPROVE OUTCOMES FOR PATIENTS WITH ADRD. IN 87% OF HH EPISODES, CLINICIANS REPORT NEEDING FAMILY CAREGIVER ASSISTANCE TO IMPLEMENT THE PLAN OF CARE AND ENGAGING/SUPPORTING FAMILY CAREGIVERS DURING HH CONTRIBUTES TO IMPROVED CARE OUTCOMES—INCLUDING REDUCED READMISSION RISK AND GREATER PATIENT AND FAMILY SATISFACTION. FAMILY CAREGIVERS ARE A CRUCIAL RESOURCE FOR THOSE WITH ADRD, INCLUDING DURING HH. HOWEVER, THERE IS CURRENTLY A DEARTH OF INFORMATION REGARDING ADRD FAMILY CAREGIVERS’ SPECIFIC ROLES AND SUPPORT NEEDS DURING HH. ANALYSES OF ADRD CAREGIVER INVOLVEMENT IN CARE DELIVERY HAVE FOCUSED ON THE AMBULATORY SETTING AND HOLD LIMITED APPLICABILITY FOR HH DUE TO THIS SETTING’S UNIQUE PAYMENT AND CARE DELIVERY STRUCTURES. PRIOR WORK EXAMINING CAREGIVER ACTIVITIES AND TRAINING NEEDS DURING HH DID NOT SPECIFICALLY EXAMINE THOSE WITH ADRD. HH PATIENTS WITH ADRD (AND THEIR CAREGIVERS) MERIT TARGETED STUDY GIVEN: THE UNIQUE CHALLENGES OF ADRD CAREGIVING, ADRD PATIENTS’ HIGHER RISK FOR ADVERSE HH OUTCOMES, AND PRIOR WORK INDICATING THAT CAREGIVERS ARE MORE LIKELY TO NEED TRAINING DURING HH IF ASSISTING A PATIENT WITH COGNITIVE IMPAIRMENT. THE GOAL OF THIS PROJECT IS TO DESCRIBE ADRD CAREGIVERS’ ROLE AND TRAINING NEEDS DURING HH, AND TO DETERMINE HOW CAREGIVER AVAILABILITY AND CAPACITY IMPACT HH CARE DELIVERY AND OUTCOMES FOR PATIENTS WITH ADRD. AVAILABILITY REFERS TO CAREGIVERS’ WILLINGNESS TO ASSIST AND HOW OFTEN THEY ARE PRESENT IN THE HOME. CAPACITY REFERS TO CAREGIVERS’ IDENTIFIED TRAINING NEEDS RELATED TO SPECIFIC CAREGIVING ACTIVITIES. WE WILL USE A NATIONAL SAMPLE OF MEDICARE BENEFICIARIES WITH DIAGNOSED ADRD (DETERMINED VIA MEDICARE CLAIMS) WHO RECEIVED HH IN 2018. WE WILL ANALYZE LINKED HH PATIENT ASSESSMENT, MEDICARE CLAIMS, AND HH AGENCY ADMINISTRATIVE DATA FOR THIS SAMPLE TO 1) CHARACTERIZE CAREGIVER INVOLVEMENT (INCLUDING TYPES OF ASSISTANCE PROVIDED, AVAILABILITY, AND CAPACITY) DURING HH; 2) DETERMINE THE IMPACT OF CAREGIVER AVAILABILITY AND CAPACITY ON HH CARE DELIVERY FOR PATIENTS WITH ADRD; AND 3) ASSESS THE IMPACT OF CAREGIVER AVAILABILITY AND CAPACITY ON HH OUTCOMES FOR PATIENTS WITH ADRD. FINDINGS WILL PROVIDE NOVEL FOUNDATIONAL EVIDENCE REGARDING ADRD CAREGIVERS’ ROLE AND SUPPORT NEEDS DURING HH, INFORMING THE DEVELOPMENT OF TARGETED INTERVENTIONS TO IMPROVE CARE FOR HH PATIENTS WITH ADRD BY BETTER ENGAGING AND SUPPORTING THEIR FAMILY CAREGIVERS.

FY2009 ARRA COLA/QI