Project Summary: Addressing racial and ethnic disparities in ADRD through the integration of local public health departments and health systems is a strategic priority, according to The National Plan to Address Alzheimer's Disease 2019. Such integration is expected to address social determinants of health and promote culturally-valid population health assessments and treatment. Investments in care coordination practices and innovative health care delivery models, such as Accountable Care Organizations (ACOs), represent an important opportunity for promoting continuity of care for people with ADRD and risk factors for ADRD. There is an urgent need to understand effective care coordination practices for racial and ethnic minority ADRD patients across hospital, community, and public health systems, and how to improve such coordination systematically through innovative health care delivery models. Our long-term goal is to build a hospital-community integrated system that delivers personalized patient-centered care to promote population health and reduce health disparities for people with ADRD and risk factors for ADRD. The objective of this project is to identify hospital- community care coordination practices and the innovative features of health care delivery models that can improve effective management of ADRD; control/reduce modifiable risk factors of; and eventually promote population health and reduce health disparities. Our central hypothesis is that integrating hospital and community care with the support of ongoing policy initiatives that promote the adoption of care coordination, such as ACOs, can significantly improve health care quality and equity. We are particularly interested in understanding how care coordination can improve care quality for racial and ethnic minorities. An additional population of interest is among the hardest-to-reach populations: racial and ethnic minorities who receive federal housing assistance (through the Department of Housing and Urban Development (HUD)) and who may have experienced periods of homelessness. We aim to identify hospital-community care coordination practices that can improve quality of care, reduce health care costs, and reduce racial and ethnic disparities (Aim 1); determine the extent to which ACO models can promote care coordination practices and reduce disparities among Medicare beneficiaries with ADRD and beneficiaries who are at an increased risk for ADRD (Aim 2); and estimate the impact of care coordination practices and ACO models on health care quality and disparities reduction among HUD-assisted populations with ADRD and populations who are at an increased risk for ADRD (Aim 3). Our aims are formulated on the basis of our preliminary findings produced under current NIA support (R56AG062315). The results of our study are expected to provide evidence on cost-effective care coordination practices that can make care integration sustainable for racial and ethnic minority populations, and break down longstanding silos and bridge the gap between hospitals, health care providers, and the public health system for people with ADRDs and risk factors of ADRDs.

NARRATIVE The proposed research is relevant to public health because results will identify care coordination practices that can promote health care quality and equity for people with risk factors or diagnoses of ADRD, with a focus on African Americans, Latinos, and the hardest-to-reach population who receive federal housing assistance through the Department of Housing and Urban Development (HUD). The results of our study are expected to provide evidence on cost-effective care coordination practices that can make care integration sustainable for underserved populations, and suggest optimal designs of health care systems, such as ACOs, to promote such care coordination practices. Thus, the proposed research is relevant to the NIA's mission (PAR-19-070, NOT-AG-18-056): “to identify which aspects of the community provide support to persons with dementia; identify the mechanisms and risk factors that explain disparities in service access and quality for persons with dementia; and identify how regulatory and economic incentives affect access, quality, and health outcomes in health systems for people with dementia.”