A writer talks to Barnato about a recent research grant on health care inequities for adults with Alzheimer’s disease and dementia-related illnesses.
Written by Aidan Silvestro | 10/18/23 2:10am
Amber Bernat is director of the Institute for Health Policy and Clinical Practice at Dartmouth’s Geisel School of Medicine and a physician health services researcher specializing in end-of-life decision-making. She currently leads a team of researchers who secured her $16.2 million grant from the National Institute on Aging. Her five-year renewal grant will allow Barnato and her team to continue studying inequities in adult health care for Alzheimer’s disease and dementia-related diseases. The team’s research includes four major projects, including Barnato’s research project focused on local policy for home and community-based services for adults with dementia.
What inspired you to study health inequalities and Alzheimer’s disease? Have you always been interested in conducting research on health care systems and Alzheimer’s disease?
AB: When I first started studying health services in the early 2000s, I became interested in health systems research. Because it seemed unfair. I started my career hoping to contribute to Medicare and Medicaid reform because I believed this should be designed to improve U.S. health care policy. I had no particular interest in Alzheimer’s disease. I succeeded Geisel Professor and Research Professor of Economics Jonathan Skinner. Skinner led the grant for 18 years, focusing on research into diseases such as heart disease, cancer and diabetes. The National Institute on Aging has secured funding for research in the field to accelerate research into Alzheimer’s disease and related dementias. So, when my research team and I tried to participate in competitive renewal, which is the time when grants are awarded every five years – in order for our research to be funded under that, Alzheimer’s disease I knew I had to focus solely on the patient. diversion.
Can you explain why disparities in Alzheimer’s disease and related dementia care are not well studied?
AB: We focus more on the biomedical aspects of Alzheimer’s disease, including what causes Alzheimer’s disease, how to prevent it, and why people get Alzheimer’s disease. Although we know more about the causes of Alzheimer’s disease, there is no cure. There is a tsunami of elderly people, but the overwhelming caregiving population has little capacity to care for them. So we bet on finding a blockbuster drug. There was a lack of investment to explore other things, but now that there are people with this disease, we want to make sure they are treated humanely and fairly.
How is research organized between research teams?
AB: We have nearly 30 researchers, including professors, research scientists, and staff from Dartmouth College, Indiana University, and Harvard University. The research is divided into his four teams.
What specific research project are you involved in in this study?
AB: I am co-leading “Project 1” and am conducting policy analysis with the research team. We account for differences between U.S. states in coverage of home- and community-based services (essentially Medicare- and Medicaid-funded services in someone’s home). If you qualify for a nursing home and have a low income, Medicaid will pay for your placement in a nursing home. But nursing homes are expensive and people don’t want to move in, so states have started experimenting with providing housewives and people to help people move around their homes. My research examines state-level heterogeneity in home and community-based services in different regions and its impact on outcomes for older adults with Alzheimer’s disease.
What areas do the other three research projects in this study focus on?
AB: “Project 2” focuses on affordable housing, which is Section 8 housing for low-income residents. The study will examine whether having a service coordinator in affordable housing communities can help people with memory loss and Alzheimer’s disease avoid unnecessary hospitalizations. Or whether this makes these patients more likely to get vaccinated. The project is led by epidemiologists and social work scientists who study healthy housing. The third project explores the characteristics of primary care that work in marginalized communities in managing chronic health conditions that can cause or promote Alzheimer’s disease, such as high blood pressure and diabetes. trying to understand. This will be a national study and will include data analysis of claims data from both medical bills and interviews. The fourth project examines the likelihood that patients will be tested in the emergency department for symptoms of chest pain due to a possible heart attack or pulmonary embolism.
What does this research mean and how will the NIA, part of the National Institutes of Health, use the findings?
AB: The NIH is solely responsible for funding research and does not actually set policy regarding health care delivery or population health. However, their goal is to fund policy-relevant research, and what is expected to be reflected in the peer-reviewed literature are mechanisms that influence policy. Therefore, my research will be published and from there consumed by policy makers. States are not required to provide these home- and community-based services, but states may decide to provide them or the federal government may Incentives may be provided. So Oklahoma may look at what we find and change its policy, but it’s more of an indirect mechanism to change its policy. The law requires policymakers and their staff to read magazine articles, or professors to write op-eds or testify before Congress to advocate for specific policies.
How can the Dartmouth community and students in particular get involved in your research and support research into inequalities in adult Alzheimer’s health and social care?
AB: We have a Geriatric Center of Excellence at Dartmouth Health where we have a group of people with Alzheimer’s disease and their families, who are our patients and our community advisory board. They help ensure that the lived experiences of patients and their carers are carefully considered. If you have students interested in these topics, they should contact the principal investigator of the project they are interested in and ask what they can do. Our projects often involve Presidential Scholars and other undergraduate researchers. Sometimes they stay for one term, sometimes they work with us for a longer period of time. But we love having undergraduates working with us. The most obvious ways to get involved are by becoming a member of the community, serving on an advisory board, or becoming an undergraduate research student.
This interview has been edited and condensed for clarity and length.
