Improving Access to Care and Chronic Condition Management for Rural Older Adults in the US

改善美国农村老年人获得护理和慢性病管理的机会

基本信息

批准号：
10483177
负责人：
Paula Chatterjee
金额：
$ 16.69万
依托单位：
UNIVERSITY OF PENNSYLVANIA
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-15 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10483177
关键词：
Address Adopted Adult Affect Affordable Care Act Aging Ambulatory Care Budgets Caring Chronic Communities Continuity of Patient Care Country Data Death Rate Development Plans Diagnosis Elderly Environment Evaluation Future Goals Growth Health Health Services Health Services Accessibility Health Services Research Health and Retirement Study Healthcare Systems Heart Diseases Hospitalization Hospitals Human Resources Improve Access Infrastructure Internist Interview Learning Skill Life Expectancy Malignant Neoplasms Measures Medicare claim Mentors Mentorship Methods Modeling Morbidity - disease rate Outcome Patient-Focused Outcomes Patients Pattern Pennsylvania Physicians Population Qualitative Methods Qualitative Research Quasi-experiment Research Research Methodology Research Personnel Risk Rural Rural Community Rural Health Rural Hospitals Rural Population Site Source Stroke Surveys System Time Training United States Universities Visit aged base care delivery career development design econometrics experience health care availability health care delivery health disparity health related quality of life implementation science improved improved outcome innovation inpatient service insight interest medical specialties mortality multidisciplinary novel novel strategies payment preservation programs prospective readmission rates response rural area rural disparities rural healthcare skills treatment as usual trend urban disparity urban health disparities

项目摘要

PROJECT SUMMARY/ABSTRACT Candidate: Paula Chatterjee, MD MPH is an early stage health services researcher and general internist interested in improving access to care for rural older adults and narrowing rural-urban health disparities. She aims to develop content expertise in aging; expand her mixed method research skills; and transition into an independent investigator dedicated to improving the health of older adults and narrowing health disparities. Research Context: Older adults make up a growing portion of rural communities in the United States (US), but have more chronic conditions and limited access to care compared to their urban counterparts. Rural hospitals, which increasingly provide essential inpatient and outpatient care for older adults, struggle financially and are at accelerating risk of closure. Global budgets for rural hospitals have been proposed as a strategy to financially bolster rural hospitals to stave off risks of closure, while transforming rural care delivery to optimally manage chronic conditions and narrow rural-urban health disparities. Understanding how global budgets might achieve these outcomes is critically important to understanding how to strengthen rural health care systems. Specific Aims: (1) Describe trends in access to care, chronic condition management, and corresponding rural- urban disparities among older adults in the US; (2) estimate changes in access to care, chronic condition management, and rural-urban disparities among older adults after the introduction of global budgets for rural hospitals; and (3) qualitatively chronic identify hospital-based facilitators and barriers to preserving access, improving condition management, and narrowing disparities for rural older adults. Research Plan: Using the Health and Retirement Study and Medicare claims, Dr. Chatterjee will first describe trends in access to care and chronic condition management, and then use a synthetic control approach to evaluate the association between the introduction of global budgets in rural Pennsylvania hospitals and these outcomes. Dr. Chatterjee will then collect primary data from rural Pennsylvania hospital executives to better understand their efforts to preserve access, improve chronic condition management, and narrow disparities. Career Development Plan: Dr. Chatterjee will (1) develop content expertise in aging and health care delivery for older adults, particularly those in rural communities; (2) broaden and solidify research skills in causal inference, qualitative methods and implementation science; and (3) execute a research agenda focused on improving the health of older adults with chronic conditions. She will achieve these goals under a team of leading experts in aging, rural health, health disparities, econometrics, and qualitative methods. Environment: The University of Pennsylvania is an ideal environment to achieve these training aims under the guidance of an experienced and multidisciplinary team of Mentors and Advisors with a strong track record in developing independent health services researchers in aging and health services research.

项目概要/摘要候选人：Paula Chatterjee，医学博士、公共卫生硕士，是一名早期健康服务研究员和普通内科医生对改善农村老年人获得护理的机会和缩小城乡健康差距感兴趣。她旨在发展老龄化方面的内容专业知识；扩展她的混合方法研究技能；并转变为致力于改善老年人健康和缩小健康差距的独立调查员。研究背景：老年人在美国农村社区中所占的比例越来越大，但与城市居民相比，他们患有更多慢性病，且获得护理的机会有限。乡村的医院越来越多地为老年人提供基本的住院和门诊护理，但在财务上陷入困境并面临加速关闭的风险。提出了农村医院的全球预算作为一项战略，在财政上支持乡村医院以避免关闭风险，同时将乡村医疗服务转变为最佳方式管理慢性病并缩小城乡健康差距。了解全球预算可能会如何实现这些成果对于了解如何加强农村医疗保健系统至关重要。具体目标： (1) 描述获得护理、慢性病管理以及相应农村地区的趋势美国老年人的城市差异； (2) 估计获得护理的机会、慢性病的变化引入全球农村预算后，老年人的管理和城乡差距医院； (3) 质量上慢性的确定以医院为基础的促进因素和障碍，以保持准入、改善条件管理，缩小农村老年人的差距。研究计划：查特吉博士将首先利用健康与退休研究和医疗保险索赔来描述获得护理和慢性病管理的趋势，然后使用综合控制方法评估宾夕法尼亚州乡村医院引入全球预算与这些之间的关联结果。然后，查特吉博士将从宾夕法尼亚州乡村医院的管理人员那里收集主要数据，以便更好地了解他们为保持准入、改善慢性病管理和缩小差距所做的努力。职业发展计划：Chatterjee 博士将 (1) 发展老龄化和医疗保健领域的内容专业知识对于老年人，特别是农村社区的老年人； (2) 拓宽和巩固因果研究技能推理、定性方法和实施科学； (3) 执行一项研究议程，重点关注改善患有慢性病的老年人的健康。她将在团队的领导下实现这些目标老龄化、农村健康、健康差异、计量经济学和定性方法方面的领先专家。环境：宾夕法尼亚大学是在以下条件下实现这些培训目标的理想环境：由经验丰富的多学科导师和顾问团队提供指导，他们在以下方面拥有良好的记录培养老龄化和健康服务研究方面的独立健康服务研究人员。