Project Summary/Abstract The number of physicians with a high proportion of evaluation and management (E&M) claims for nursing home (NH) patients, often referred to as “SNFists” or “NH specialists,” grew from 1496 in 2007 to 2225 by 2014, representing a 48.2% increase. Despite this increase, virtually nothing is known about the relationship between physician specialization in NH care and the quality of care provided to long-stay NH residents. This is particularly important for residents with Alzheimer's Disease and Related Dementias (ADRD). ADRD billion receiving is a progressive, incurable illness that accounts for $226 in health care spending annually. The majority of costs are incurred among individuals in later stages of the disease long-term care. The average life expectancy 4 to 8 yearsfollowing a diagnosis of ADRD is , although some individuals may survive up to 20 years. 75% of people with ADRD will be admitted to NHs by the age of 80 compared to 4% of the general population. Amongindividuals with ADRD, approximately 70% will die inNHs. Both the long duration of the disease and the reliance on NH care increases the importance of improvements in the quality of care provided to long-stay NH residents with ADRD. Physician involvement is essential to the delivery of long-term care of high quality to residents with ADRD in NHs. Within NHs, physicians are responsible for developing and overseeing comprehensive care planning for residents. Physician specialization in NH care may improve their effectiveness by developing knowledge of NH regulations, drug guidelines, and common behavioral syndromes faced by NH residents with ADRD. Specialization in NH care may also help physicians build long-term relationships with patients and families/caregivers leading to better recognition of the needs of both. The primary objective of this study is to determine if physicians who specialize in NH care provide higher quality care to residents with ADRD. This will be done through both quantitative analyses of claims data and analyses of qualitative data collected through semi-structured interviews of NH leadership. The training that I receive through this award will provided me with knowledge of the clinical care received by ADRD patients as well as training in qualitative research methods that complement the quantitative skills that I already possess. The rich skillset that I develop through this training will allow me to connect the results of qualitative and quantitative research that generates much-needed evidence to inform policies and clinical guidelines to optimize the role of physicians in the care provided to long-stay NH residents with ADRD.

Project Narrative Seventy-five percent of people with Alzheimer's disease and related dementias (ADRD) will be admitted to nursing homes by the age of 80 compared to 4% of the general population and approximately70% of individuals with ADRD will die in these facilities. Physician involvement is essential to the delivery of high quality long-term care in nursing homes for these patients. The objective of this study is to determine if physicians who specialize in nursing home care provide higher quality care to long-stay residents with ADRD.