# Effect of Hospital and Community Care Coordination on Health Care Quality and Equity among Individuals with Risk Factors or Diagnosis of ADRD

> **NIH NIH R01** · UNIV OF MARYLAND, COLLEGE PARK · 2021 · $411,158

## Abstract

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 bre...

## Key facts

- **NIH application ID:** 10126480
- **Project number:** 1R01AG062315-01A1
- **Recipient organization:** UNIV OF MARYLAND, COLLEGE PARK
- **Principal Investigator:** Jie Chen
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $411,158
- **Award type:** 1
- **Project period:** 2021-03-01 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10126480

## Citation

> US National Institutes of Health, RePORTER application 10126480, Effect of Hospital and Community Care Coordination on Health Care Quality and Equity among Individuals with Risk Factors or Diagnosis of ADRD (1R01AG062315-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10126480. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*