Thursday, May 9, 2024
5/9/2024
Project Summary. Community-dwelling older adults with ADRD face significant challenges under the pandemic of COVID-19: they are not only at high risks for COVID-19 infection and mortality, but also at high risks for the negative consequences of a disruption in usual outpatient care. Older adults with ADRD have high care needs and rely on timely and regular outpatient care to manage ADRD and other co-exiting conditions. The consequence of disruption in usual care could be even greater among racial/ethnic minorities with ADRD, as Blacks and Hispanics generally have a greater disease burden than their white counterparts. To improve care access, the CMS expanded the coverage of telemedicine in March 2020. Although there has been significant increase in the telemedicine use since then, it is unknown how the CMS' telemedicine policy affects care among community-dwelling older adults with ADRD; and how it varies by racial/ethnic minorities. Indeed, there are concerns that the telemedicine policy may widen racial/ethnic disparities in health care. Therefore, the main objective of this proposed research is to understand the effect of CMS' telemedicine policy on health care utilization that are not directly related to COVID among community-dwelling older adults with ADRD, and its variations by race/ethnicity. This study has 3 Specific Aims: SA1.To examine racial/ethnic disparities in the utilization of usual outpatient care among community-dwelling older adults with ADRD, before and after changes in CMS telemedicine policy. We hypothesize that Blacks and Hispanics have fewer usual outpatient visits than whites after the implementation of telemedicine policy, accounting for prior health care utilization. We will examine the utilization of usual outpatient care from several dimensions. SA2.To examine racial/ethnic disparities in the relationship between the telemedicine policy and ambulatory care sensitive (ACS) hospitalizations, emergency room (ER) visits and observation stays. We hypothesize that racial/ethnic minorities with ADRD are less likely to benefit from the expansion of telemedicine, in preventing these ACS acute events. We will also examine how the disparities, if detected, are affected by the access to telemedicine. Several statistical models (e.g. interrupted time series regression) will be adopted and stratified analyses (by state and socio-economic status of a community) will be performed for SA 1&2. SA3. To explore caregivers' perspectives regarding benefits, barriers and challenges of telemedicine use among white, Black and Hispanic community-dwelling older adults with ADRD. This proposed research is innovative because it is the first study to examine racial/ethnic disparities in the relationship between the telemedicine policy and health care utilization among community-dwelling older adults with ADRD, by using a mixed-method approach. This proposed study is significant because findings will provide information on improving care equity among ADRD population, both during the pandemic and beyond. Findings will also provide the premise for future studies to collect data on a larger scale to understand the root cause in health disparities among this population.
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