Healthcare Decision-Making and Outcomes for People Living with Alzheimer's Disease - Projects

Project 1 (2024-2029) - HEARTSPOT: Evaluating a Machine Learning System to Aid Decision-Making in the Emergency Department for Patients with ADRD

An emergency department clinician treating a patient with acute coronary syndrome (ACS) faces difficult decisions about whether to recommend invasive treatment. If the patient is cognitively impaired, assessing health risks and benefits is even more complex. This project will test a machine learning tool called HEARTSPOT that helps clinicians make this difficult decision. HEARTSPOT examines each patient’s medical history faster and more completely than any human could and presents a summary of its findings to the emergency department clinician in real time.

Project 2 (2024-2029) - Provider-Patient/Caregiver Racial Concordance and Equity in Health Care Systems: Their Influence on Health and Healthcare Outcomes for Populations with ADRD

Provider/patient racial concordance and workforce diversity in medicine are important for medical decision making and patient wellbeing. Concordance may impact trust and other social factors that may be particularly important for patients with ADRD because of diminished ability for self-advocacy. Prior evidence suggests that minoritized patients' trust in medicine may be enhanced when they are paired with a race-concordant provider. This project is investigating the extent of racial concordance between providers and patients, drivers of concordance, and causal impacts of a concordant match on health care use and health.

Project 3 (2024-2029) - Inside the Black Box of Clinical Decision-Making: Provider Practice Habits, Provider Caseloads, and Implications for Patients with ADRD

This project uses innovative granular data on provider and patient activities in the Emergency Department to study health care outcomes for people living with ADRD as well as the providers who treat them. It examines differences in provider practice patterns for patients living with and without ADRD, ties those differences to provider characteristics, and investigates the impact of provider fatigue and cognitive load on care patterns and health outcomes. The findings will yield insights into tools to identify and address the underlying drivers of the quality of care delivered to patients with ADRD and thereby improve health and reduce disparities.

Project 4  (2024-2029) - The Health Impact of Administrative Burdens for People with ADRD

Individuals with Alzheimer's disease and related dementias (ADRD) face many administrative hassles when interacting with the healthcare system.  This project documents the exposure of people with ADRD to these hassles and uses quasi-experimental methods to study the causal effects of administrative hassles associated with accessing care as well as public assistance programs on access to healthcare and health outcomes for people living with ADRD.

Project 5 (2024-2029) - Effects of Nursing Home Payment on Patient-Centered Outcomes for Older Adults and People with ADRD

Nursing homes are key sources of care for millions of older adults, especially those with dementia, but many facilities are unable to consistently deliver high-quality care for these vulnerable patients. To explore the role of payment rates as a tool to address these gaps in quality, this project leverages two recent Medicare nursing home payment reforms as natural experiments. It considers the effects of payment on the quality and safety of care for skilled nursing patients, the mechanisms like staffing that drive these effects, "spillover" effects onto long-stay patients, and the implications of payment changes for disparities in care access and quality. These results will illuminate the benefits and potential unintended consequences of payment reforms and guide future efforts to improve healthcare quality and value for individuals with dementia.