OTHER PROJECT INFORMATION – Project Summary/Abstract Understanding and Improving Healthcare Decision-Making and Outcomes for People Living with Alzheimer's Disease and Related Dementias This Program Project analyzes and seeks to improve healthcare practice patterns, decision-making processes, and treatment effectiveness for patients with Alzheimer’s disease and related dementias (ADRD). Supported by a set of cores that draw together clinical and economic expertise, vast novel data sources, and cutting-edge analytical tools, the component projects focus on the particular decision-making challenges faced by providers, caregivers, and patients in caring for the complex needs of people living with ADRD and the role these play in driving disparities in access and outcomes. There are unique aspects, potential barriers, and disparities in how healthcare systems provide healthcare to people with ADRD, as these patients may be less capable of describing their symptoms and health histories, or following through on medical recommendations, and they may rely substantially on formal and informal caregivers in navigating healthcare services. We seek to understand and improve healthcare decision-making and outcomes for patients with these complex needs. The Program’s component research projects address influences on healthcare decisions, and their impact on outcomes and disparities, across a set of health conditions and settings. We deploy innovative machine learning methods both to characterize patients’ needs and treatment patterns and to build tools that can assist physicians with patient diagnostics, even when patients’ communication of their symptoms and health histories may be limited. We examine the factors that affect both provider and patient decision-making, including pressured decision-making environments such as Emergency Departments, patient-provider race, administrative burdens on patients and caregivers such as complex insurance rules, provider incentives, and providers’ patient caseload and fatigue in influencing healthcare delivery and health outcomes for patients with ADRD. Integrative support for the Program Project is advanced through three cores that provide common infrastructure, data, and expertise needed by the projects, and to ensure that they work synergistically and seamlessly as a cohesive program.

OTHER PROJECT INFORMATION – Project Narrative The rising prevalence of Alzheimer’s disease and related dementia (ADRD) with an aging population represents a profound and emergent challenge for our health and long-term care systems. There are also unique aspects and potential barriers to providing healthcare to people with ADRD, who may be less capable of communicating their symptoms and health histories or following through independently on prescribed treatments, and who often rely on family members and other caregivers for support. The proposed research evaluates processes, tools, or policies that may improve decision-making, healthcare access and delivery, and outcomes for people living with ADRD.