Impact of physician, hospital, and skilled-nursing facility factors related to geriatric care on days spent at home among persons with AD/ADRD
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Abstract Although many persons living with Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) prefer to remain at home as long as possible, they spend a great deal of time in institutional settings, such as acute care hospitals, skilled-nursing facilities (SNFs), and long-term care nursing homes. Days spent at home (DAH) has emerged as a person-centered outcome measure for AD/ADRD care, given that patients value DAH more than other clinical outcome measures, including mortality and hospital readmission rates. However, there is a lack of evidence regarding the role of clinicians and health care organizations in determining DAH in the context of AD/ADRD care. This knowledge gap has hindered efforts to develop interventions that could effectively optimize DAH among persons living with AD/ADRD. Research has shown that certain physician, hospital, and SNF factors related to geriatric care are associated with improved quality of care and patient outcomes for older adults, including subspecialty training in geriatrics, interdisciplinary teams of clinicians, and greater experience with older populations (i.e., volume). Literature also suggests that relationships between physicians, hospitals, and SNFs (e.g., health system) are associated with better outcomes. However, studies have not focused on AD/ADRD care or investigated DAH; therefore, the impact of such factors on DAH among persons living with AD/ADRD remains unknown, despite these factors being particularly relevant due to the AD/ADRD population’s unique clinical needs. We seek to examine the role of these factors in three important clinical settings using Medicare data linked to other nationally representative data sets with the following aims: (1) determine the effect of physician factors related to geriatric care(([1] subspecialty certification in geriatrics, [2] number of treated patients with AD/ADRD, and [3] health system affiliation) on DAH among persons with AD/ADRD in the ambulatory care setting (Aim 1); (2) determine the effect of hospital factors related to geriatric care ([1] staff-to-patient ratio of interdisciplinary team members, [2] number of treated patients with AD/ADRD, and [3] participation in geriatric programs) on DAH among persons with AD/ADRD who are discharged from an acute care hospital (Aim 2); and (3) determine the effect of SNF factors related to geriatric care ([1] staff-to-patient ratio of interdisciplinary team members, [2] number of treated patients with AD/ADRD, and [3] hospital-based status) on DAH among persons with AD/ADRD who receive post-acute SNF care (Aim 3). The proposed study will inform future policies to improve AD/ADRD care, such as providing incentives for bolstering geriatric training, a higher case volume of patients with AD/ADRD, and interdisciplinary care.
