A writer talks to Barnato about her recent research grant on health care inequities for adults with Alzheimer’s disease and dementia-related diseases.
Amber Barnato is director of the Institute for Health Policy and Clinical Practice at Dartmouths Geisel School of Medicine and a physician health services researcher focusing on end-of-life decision making. She currently leads a team of researchers that received a $16.2 million grant from the National Institute on Aging. The five-year grant extension will allow Barnato and her team to continue studying health care inequities for adults with Alzheimer’s disease and dementia-related diseases. The group’s research includes four main projects, including the Barnatos research project, which focuses on regional policies on home and community-based services for adults with dementia.
What motivated you to research health disparities and Alzheimer’s disease? Have you always been interested in conducting research on healthcare systems and Alzheimer’s disease?
AB: Back in the early 2000s when I first started studying health services, I was interested in studying the health care system because it seemed unfair. I think American health care policy should be designed to improve something, so I started my career wanting to help reform Medicare and Medicaid. I have no specific interest in Alzheimer’s disease; I replaced professor Geisel and economic studies professor Jonathan Skinner, who led the grant for 18 years and focused on research into diseases such as heart disease, cancer and diabetes. The National Institute on Aging earmarks money to study Alzheimer’s disease and related dementias to advance research in that area. So when my research team and I set out to do a competitive innovation, which is when you get a grant every five years, we understood that it had to be focused exclusively on these diseases. patients with Alzheimer’s disease if our research is to be funded under that allocation.
Can you explain why the disparities in Alzheimer’s disease and related dementia care remain understudied?
AB: We focus more on the biomedical aspects of Alzheimer’s disease, like what causes it, how we can prevent it, and why people get it. We know more about what causes Alzheimer’s disease, but we don’t have any treatments. We have this wave of older people and virtually no capacity to care for them, with an overwhelming number of caregivers. So we bet on the hope of finding this blockbuster drug. There has been underinvestment in exploring other things, but now that we have people with this disease, we want to make sure that they are treated humanely and fairly.
How is research organized across research groups?
AB: There are nearly 30 researchers, including professors, research scientists and staff from Dartmouth College, Indiana University and Harvard University. Research is organized into four teams.
What specific research projects were you involved in this study?
AB: I’m co-leading project one, where my research team and I are doing policy analysis. We’re looking at differences across US states in coverage for 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. However, nursing homes are expensive and people don’t want to go into them, so states have started experimenting with providing a homemaker and someone to help shuttle people into their homes. . My research explores state-level heterogeneity of 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: The second project focuses on affordable housing, which is housing in Zone 8 for low-income people. This study will examine whether having a resident services coordinator in an affordable housing community helps patients with memory problems and Alzheimer’s disease avoid unnecessary hospitalizations. Or whether this increases the likelihood of these patients being vaccinated. This project is led by an epidemiologist and a social work scientist who studies housing in the health sector. The third project is trying to understand the features of primary care that work with marginalized communities in managing chronic health conditions that can lead to or accelerate Alzheimer’s disease, such as increased blood pressure, diabetes, etc. This will be a national study and will include data analysis of claims data from medical bills and interviews. The fourth project looked at the possibility of a patient being tested in the emergency department for symptoms of chest pain due to a possible heart attack or pulmonary embolism.
What is the significance of this study and how will the NIA, part of the National Institutes of Health, use the study results?
AB: The NIH is exclusively responsible for funding research and does not actually set policies regarding health care delivery or public health. However, their goal is to fund policy-relevant research and the expectation that it is the mechanism to influence policy that is included in the peer-reviewed literature. So my research will be published, and from there, it will be used by policymakers. Although states are not required to provide these home-based and community-based services, they may decide to do so, or the federal government may create incentives if they believe that will help save money and improve older adults’ autonomy. So it’s possible that Oklahoma saw what we found and changed their policies, but that’s a more indirect policy change mechanism. It requires policymakers or their staff to read journal articles, or professors to advocate certain policies by writing an editorial or testifying before Congress.
How can the Dartmouth community and students in particular participate in your research or generally support research on inequities in health and social care for adults with Alzheimer’s disease?
AB: We have the Geriatric Center of Excellence at Dartmouth Health and they have a group of Alzheimer’s disease patients and their family members who are our patient and community advisory board. They are helping us ensure that we think critically about the real-life experiences of patients and their caregivers. If any students are interested in these topics, they should contact the principal investigators of the project they are interested in and ask what they can do. We often have Presidential Scholars or other undergraduate researchers participate in our projects. Sometimes they only stay with us for a while, sometimes they work with us longer. However, we love having college students working with us. And those are the most obvious ways to get involved: become a community member, join an advisory board, or be an undergraduate research student.
This interview has been edited and condensed for clarity and length.
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