# The Impact of physician and health system factors on the quality of care for persons with Alzheimer's disease and related dementias at the end of life

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA LOS ANGELES · 2021 · $639,692

## Abstract

Project Summary
Evidence indicates that individuals with Alzheimer's disease and related dementias (ADRD) often receive
suboptimal care at the end of life (EOL). Although patient factors (e.g., socioeconomic status, caregiver
support) clearly affect the quality of EOL care, studies also demonstrate wide variations in how physicians and
health systems treat terminally-ill patients. However, existing studies on the quality of palliative and EOL care
have been focused primarily on patients with cancer, and evidence is limited as to the quality of EOL care for
persons with ADRD. Indeed, little is known about physician and health system factors that are associated
with the quality of palliative and EOL care for persons with ADRD. These knowledge gaps have hindered
efforts to develop interventions that can effectively improve the quality of EOL care for persons with ADRD.
The proposed R01 will create a comprehensive, multi-level database that includes detailed information about
patients, physicians, and health systems, by linking three large, nationally-representative datasets: (1)
Medicare claims data (patient factors), (2) Doximity Physician Database (physician factors), and (3) RAND
Health System Database (health system factors). In Aim 1, using this innovative database, we will identify
physician factors (e.g., age, sex, clinical experience, specialty, residency and fellowship training in geriatrics
and/or palliative care) that are associated with the quality of EOL care (defined as (1) the receipt of advance
care planning, palliative care, and hospice, (2) aggressiveness of EOL care, and (3) patient outcomes) for
persons with ADRD. In Aim 2, we will identify health system factors (e.g., academic medical centers, profit
status, size, region, ACO status) associated with the quality of EOL care for persons with ADRD. In Aim 3,
focusing on physicians who practice at multiple health systems (about 21% of physicians practice at multiple
health systems), we will investigate whether health system factors influence physicians' aggressiveness of
EOL care for persons with ADRD. The proposed R01 will provide a unique opportunity to advance the field by
better understanding the mechanisms of how physicians and health systems affect the quality of EOL care
provided to persons with ADRD, with a special focus on mutable physician factors (e.g., education and training
in geriatrics and/or palliative care) and health system factors (e.g., financial incentives) that contribute to the
quality of EOL care. This project will provide a strong evidence base for developing interventions (e.g., CME for
physicians targeted at palliative and EOL care for persons with ADRD, financial incentives for ACOs), which
can effectively improve the quality of care for persons with ADRD at the EOL. The research team consists of
multiple NIH-funded researchers with expertise in all relevant fields (health services research using big data,
Alzheimer's disease and dementia research, pallia...

## Key facts

- **NIH application ID:** 10260421
- **Project number:** 5R01AG068633-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA LOS ANGELES
- **Principal Investigator:** Yusuke Tsugawa
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $639,692
- **Award type:** 5
- **Project period:** 2020-09-15 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10260421

## Citation

> US National Institutes of Health, RePORTER application 10260421, The Impact of physician and health system factors on the quality of care for persons with Alzheimer's disease and related dementias at the end of life (5R01AG068633-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10260421. Licensed CC0.

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