. Most persons with Alzheimer's disease or related dementia (ADRD) need nursing home (NH) care during the course of the illness, as they experience a loss of functional independence and develop behavioral and psychiatric symptoms of dementia (BPSD). Studies have indicated that Blacks with ADRD are more likely to have higher levels of cognitive impairment and BPSD than Whites with ADRD, thus intensifying their needs for NH care. However, in spite of potentially higher needs for NH care, there is only limited information on quality of care received by Black residents with ADRD. Many questions left answered. First, although studies have suggested that Blacks in general are less likely to be admitted to higher-quality NHs, which leads to ?between-NH? racial differences, it is unknown whether these findings can be generalized to persons with ADRD, considering unique care needs among residents with ADRD. Furthermore, it is unknown whether such racial differences can be affected by government policies aimed at improving NH dementia care (i.e. the CMS's public reporting of antipsychotic use in NHs and state Medicaid dementia/behavioral add-on payment adjustment). Second, it is unknown whether Blacks with ADRD experience different quality outcomes than their White counterparts within the same facility after being admitted into NHs (i.e. ?within-NH? differences), whether such racial differences vary with different phases of NH care (i.e. post-acute care, long- term care, and/or end-of-life care), and how much of such differences, if any, can be explained by observed individual characteristics. This proposed research aims to address these gaps in knowledge. The objectives of this proposed research is to understand racial differences in quality of NH care among residents with ADRD, to explore the sources of racial differences and factors that may influence racial differences. By using 2011-2017 national data, the study has two Specific Aims: 1) Examine the extent to which Black residents with ADRD are less likely to be admitted to higher-quality NHs (?between-NH? differences). We hypothesize that Blacks with ADRD are less likely to be admitted to high-quality NHs than their White counterparts, and that such racial difference will be larger following CMS's public reporting of NH antipsychotic use; and smaller in states with Medicaid add-on payment for dementia/behavioral problems; and 2) Examine within-NH racial differences in quality outcomes among residents with ADRD, at each phase of NH care. We hypothesize that that Blacks with ADRD experience poorer quality outcomes than their White counterparts in the same NH. We will also explore how much of the racial differences can be explained by observed individual characteristics. This study is innovative because it will be the first national study to address these questions among persons with ADRD. This proposed research is significant as it addresses a public health concern on NH care received by residents with ADRD. Achieving equity is crucial in quality improvement. Findings from this study will inform future efforts aimed at reducing unwarranted differences and improving dementia care for this vulnerable population.
The proposed research is highly relevant to public health because it addresses an important issue ? racial differences in quality of nursing home care among persons with Alzheimer's disease and related dementia (ADRD), and whether such differences can be explained by individual factors and be affected government policies. As stated by IOM, achieving equity is crucial in quality improvement. Findings from this study will provide information on policies aimed at improving care among persons with ADRD and reducing unwarranted racial differences for this vulnerable population.
