Detalles del proyecto
Description
Currently, 10.7% of Americans aged 65 and older have Alzheimer's Disease and Alzheimer's Disease Related
Dementias (AD/ADRD). By 2050, 14% (12.7 million) will be affected. Racial and ethnic minorities bear uneven
burdens; nearly 19% of Black and 14% of Hispanic older adults have AD/ADRD compared to 10% of White
older adults. Patients with AD/ADRD (referred to as Persons Living with Dementia [PLWD]) often lack access
to high-quality care and have poorer outcomes, such as higher hospital and emergency department (ED) use.
While caring for PLWD and eliminating health disparities are national priorities, the current primary care system
is ill-prepared, mainly due to primary care physician shortages. Nurse practitioners (NPs), the fastest-growing
primary care workforce, who disproportionately care for racial and ethnic minorities, are vital for dementia care.
Increasingly, NPs lead team-based care, and primary care models that leverage NP teams can address PLWD
disparities. Yet, NP teams are poorly studied, and little is known about which teams deliver the best care. To
design high-performing NP teams, it is key to identify members of NP teams (team configuration), understand
how team members communicate, seek advice, and share support, and show how these connections (social
networks) affect PLWD outcomes. Building on our work on teams, social networks, dementia care, and health
disparities, our novel, national mixed-methods study will produce this evidence. Using novel methods, including
social network analysis (SNA), positive deviance, and the Delphi technique, we aim to 1. Identify NP team
configurations and social networks (i.e., communication, advice, trust, support, and problem-solving) in primary
care practices caring for PLWD. 2. Assess how NP team configurations and social networks impact PLWD
outcomes (i.e., hospitalizations, ED use) and evaluate racial and ethnic disparities in these outcomes. 3.
Identify barriers, facilitators, and characteristics of teamwork in NP teams with different configurations and
social networks. 4.Develop and disseminate practice and policy recommendations to design and implement NP
teams in primary care practices to care for PLWD and achieve health equity. We will conduct a social network
survey of a national sample of NPs caring for PLWD to map their teams using SNA. By merging these data
with data on hospital and ED use and applying regression models, we will assess the NP team's impact on
PLWD outcomes and racial and ethnic disparities. Using positive deviance, we will interview NPs from variably
configured teams (e.g., small, large) and with different networks (e.g., highly, poorly connected) from Aim 1 to
understand the context in which NP teams function. We will triangulate findings to design practice and policy
recommendations and refine them through Delphi method with a panel of patient advocates, practice leaders,
clinicians, and policy experts. Our findings will inform key stakeholders seeking to enhance dementia care
delivery and the effectiveness of the dementia workforce. Our application is in response to Notice of Special
Interest (NOSI) NOT-AG-21-049 to enhance the Dementia Care Workforce for Those Living with AD/ADRD.
Estado | Activo |
---|---|
Fecha de inicio/Fecha fin | 5/15/24 → 1/31/25 |
Keywords
- Neurología clínica
- Neurología
- Enfermería avanzada y especializada
Huella digital
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