Impact of Nursing Home Leadership Care Environments and Health Information Technology on Outcomes of Residents with Alzheimer's Disease and Related Dementias (ADRD)

Our study examines the Impact of Nursing Home Leadership, Care Environments and Health Information Technology on Outcomes of Residents with Alzheimer’s Disease and Related Dementias (ADRD). Approximately 42% of 1.3 million nursing home (NH) residents have ADRD. NH residents with ADRD have frequent and longer length of stays than residents with other types of chronic illnesses. Nurse practitioners (NPs) are a predominant provider of NH care in the U.S. for residents with ADRD including 11,222 clinicians providing care in 5000 facilities. A growing strategy for improving resident outcomes is to effectively integrate health information technology (HIT) into NH care delivery. The use and integration of HIT into resident care, clinical support and administrative activities (known as HIT maturity) enhances care coordination and communication between NPs and staff, enabling NPs to manage resident health conditions better and improve resident outcomes. Evidence supports that NPs deliver higher quality care to residents in more positive care environments with supportive collegial relationships, greater access to resources and information. Studies focusing on care of NH residents with ADRD confirm that technology, shared communication, and care environments with clearly defined NP roles, helpful relationships, and supportive care lead to improved quality. We will examine the impact of NH HIT maturity and care environments on outcomes of residents with ADRD including hospitalizations and emergency department visits. Our specific aims are: 1) Provide comprehensive assessments of HIT maturity and NP care environments in NHs caring for residents with ADRD, 2) Examine the impact NH HIT maturity and NP care environments on disparities among residents with ADRD, and 3) Explore facilitators and barriers for achieving improved outcomes of residents with ADRD with diverse HIT maturity and care environments from the perspectives of NH administrators and NPs. During Aim 1 we will survey administrators and NPs from 1400 NHs collecting HIT maturity and care environment data from each discipline. We will link surveys to national NH data. We will assess differences in HIT maturity and NP care environments by NH characteristics. The association between HIT maturity and care environments will also be tested. During Aim 2 we will explore the potential mediating role of care environment on the relationship between HIT maturity and health outcomes. We will link surveys and resident level data (i.e. Medicare claims) during the same years’ surveys are conducted. During Aim 3 we will conduct key informant interviews with NH administrators (n = 70) and NPs (n = 70) representing diverse HIT maturity and care environments. Understanding HIT maturity and care environments where administrators and NPs work will help us identify methods to unlock their maximum potential to improve quality of NH care for residents with ADRD. We will identify differences in HIT maturity and care environments in NHs where administrators and NPs work, allowing us to identify targeted interventions that can be implemented to improve outcomes of residents with ADRD.