Due to the growing prevalence of Alzheimer?s disease and related dementias (ADRD) among elder Hispanics, the Alzheimer?s Association has emphasized the importance of conducting research to learn more of this con- dition in the Hispanic population. Hispanics have been one of the fastest-growing minority groups among nurs- ing home residents while the number of White residents is decreasing. However, most studies about ADRD care for Hispanics have focused on family caregiving, with very little research about nursing home care. All of the prior research on the care and outcomes of patients with ADRD is derived from patients enrolled in tradi- tional Medicare, with remarkably few studies of persons with ADRD in managed care plans. Even though the Medicare Advantage (MA) program plays a critical role in financing and delivering care for older minorities, es- pecially Hispanics since approximately 40% are enrolled in MA. This raises a critical gap in knowledge be- cause over the past 12 years, the number of beneficiaries enrolled in managed care more than tripled from 5.3 million in 2004 to 17.6 million in 2016. MA plans, which are accountable for their clinical performance, have implemented strategies to improve care, either by selectively contracting with high-performing providers or di- rectly initiating care management strategies for those with complex health care needs. This could be the key to the delivery coordinated, patient-centered, and cost-effective care for people with ADRD. Whether the unique payment and organizational structure of managed care plans translates into differential use and outcomes of nursing home care for minority people with ADRD is unknown. The objective of this R03, the next step in this agenda, is to assess disparities among Hispanics in the quality of ADRD care in a national sample of Medicare enrollees in fee-for-service and MA plans. Our working hypotheses are that, among persons with ADRD, His- panics with ADRD would be more likely to receive care from lower quality long-term care providers, and that managed care would reduce disparities in quality of care.
Our specific aims are:
Aim 1. To evaluate the quality of nursing home care that serve newly admitted MA and Medicare fee-for-service Hispanic patients with ADRD compared to non-Hispanic whites with ADRD;
and Aim 2. To characterize within- and between- nursing home?s disparities in short- and long-stay resident?s outcomes for Hispanics with ADRD. This project will use detailed comprehensive clinical and functional assessment data from all Medicare-certified nursing homes in the US. Our expectation is that this project will provide understanding of disparities in health care quality of formal nurs- ing home care for those with ADRD. Our results can inform Medicare policies that promote better quality of care for Hispanics by understanding the role of managed care plans in lowering racial-ethnic variations. Our contribution is significant since federal policy continues to promote beneficiaries? enrollment in MA plans with- out evidence about the quality of care for vulnerable populations, such as Hispanics with ADRD.
This research is relevant to public health because it will provide important information on disparities regarding nursing home care for Hispanic Medicare Advantage and fee-for-service beneficiaries with Alzheimer?s disease and related dementias (ADRD). Medicare Advantage plans integrate the financing and delivery of care, which may be the key to the delivery coordinated, patient-centered, and cost-effective care for people with ADRD. Thus, the proposed research is relevant to the NIH's mission to redress and identify mechanisms to reduce, and ultimately eliminate, health disparities.
