Advanced Provider Care Models and Health Outcomes of Nursing Home Residents with Dementia
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PROJECT SUMMARY The quality of care for the over 800,000 residents of US nursing homes (NH) with Alzheimer's disease or related dementias (ADRD) is variable and outcomes are poor. The physician and advanced practitioner (predominantly nurse practitioner) workforce plays a key role in the quality of care for NH residents with ADRD, who tend to be more clinically complex and require more care coordination compared to residents without ADRD. These clinicians work with direct care NH staff to diagnose and treat acute complaints, manage chronic conditions, prescribe medications, perform minor procedures, and communicate with families about prognosis and goals of care. However, little care clinician care models characteristics and potentially is known about the characteristics and outcomes of different NH clinician models in the care of NH residents with ADRD. We propose to characterize and evaluate the that provide general medical care to NH residents with ADRD. Understanding the and outcomes of existing models of NH clinician care for residents with ADRD will inform policy practice interventions to achieve higher quality care with better outcomes and l ower utilization of avoidable healthcare that is particularly harmful in this population. Thus, different NH our long-term goal is to improve the quality of care for NH residents with ADRD by evaluating and disseminating information on high- performing NH clinician care models. To do so, we will survey a nationally representative sample of NH clinicians about their practice characteristics, organization, processes of care, and degree of co-management between different provider types. Next, we will link these data on NH clinician – predominantly NP-physician models - to Medicare claims and the NH Minimum Data Set to measure the outcomes and costs of care for NH residents with ADRD. We hypothesize that NH residents with ADRD under the care of clinicians with a high degree of co-management (scores in the top vs. bottom quartile on the co-management scale) have better outcomes (slower decline in functional status, fewer ambulatory care sensitive hospitalizations) and lower costs (facility and professional payments by Medicare) compared to clinicians with a low degree of co- management. This evidence will inform efforts by policymakers and NH providers to improve health outcomes and reduce costs for NH residents with ADRD by aligning reimbursement, scope of practice, and regulations mandating the timing of clinician visits, better supporting high-performing clinician care models for residents with ADRD.
