Sociodemographic predictors of healthcare utilization and adverse outcomes in Medicare beneficiaries with glaucoma

患有青光眼的医疗保险受益人的医疗保健利用和不良后果的社会人口学预测因素

• 批准号: 10487442
• 负责人: Nazlee Zebardast
• 金额: $ 20.53万
• 依托单位: MASSACHUSETTS EYE AND EAR INFIRMARY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10487442
• 关键词: Accidents; Address; Admission activity; Adverse event; Affect; Age; Aging; Area; Black Populations; Blindness; COVID-19 pandemic; Caring; Characteristics; Chronic; Code; Communities; Complex; Current Procedural Terminology Codes; Data; Diagnosis; Elderly; Eye; Femoral Fractures; Gender; Glaucoma; Health; Health Care Costs; Health Policy; High Prevalence; Hispanic Populations; Home Health Aides; Hospitalization; Individual; Inpatients; International Classification of Diseases; Intervention; Length; Measures; Medicare; Medicine; Mental Depression; Modeling; Morbidity - disease rate; Nursing Homes; Operative Surgical Procedures; Ophthalmic examination and evaluation; Outcome; Patients; Personal Satisfaction; Physiological; Population; Prevalence; Public Health; Quality of life; Race; Research; Research Personnel; Risk; Risk Factors; Rural; Sampling; Severities; Socioeconomic Factors; Socioeconomic Status; System; Testing; Time; United States; Vision; Visual impairment; Vulnerable Populations; Work; adverse outcome; base; beneficiary; black patient; burden of illness; care coordination; care outcomes; care providers; care systems; cohort; comorbidity; density; disability; experience; fall injury; falls; follow-up; frailty; health care service utilization; health difference; improved; improved outcome; indexing; low socioeconomic status; minority patient; mortality; population based; racial disparity; racial minority; risk stratification; rural residence; sex; social deprivation; sociodemographic predictors; sociodemographics; socioeconomic disparity; socioeconomics

PROJECT SUMMARY/ ABSTRACT Patients with glaucoma experience an increased risk of adverse health-related outcomes, including falls, injuries, femur fractures, and depression. In the United States, racial and socioeconomic (SES) disparities exist in glaucoma prevalence, visual impairment, and eye-care utilization. However, we do not know if these disparities result in differences in vision- and health-related outcomes between different groups. Furthermore, while it is known that frailty among older adults has implications for morbidity, mortality, and healthcare costs, the relationship between frailty and healthcare utilization and outcomes in older adults with glaucoma has not been explored. We hypothesize that there are detectable differences on the use of eye care services and subsequently in vision- and health-related outcomes among older adults with glaucoma based on race and SES. We further hypothesize that older adults with a higher frailty score and more comorbidities will be less likely to use eye care services and will have worse vision- and health-related outcomes from glaucoma. To address these hypotheses, we will analyze the existing data from a 5% sample of Medicare beneficiaries from 2014-2016. We will assemble a cohort of glaucoma patients as well as a matched control cohort. Our analyses are aimed at answering 3 specific aims: 1) are there differences in eyecare utilization among older glaucoma patients based on race, SES and frailty and is there an interplay between sociodemographic characteristics and frailty? 2) Are glaucoma patients belonging to vulnerable populations based on race, SES and frailty more likely to experience adverse vision related outcomes? And finally 3) are there differences in health utilization and adverse outcomes among glaucoma patients based on their race and SES? We hypothesize that the impact of glaucoma on overall morbidity and function is unevenly distributed, with vulnerable populations carrying a greater risk or poor health outcomes. The research outlined here will improve our understanding of the complex interplay of factors contributing to disparities in glaucoma care and outcomes. This study will enable us to identify gaps in care among vulnerable populations and identify possible areas for intervention.

项目摘要/摘要 青光眼患者患健康相关结果的风险增加，包括跌倒，伤害， 股骨骨折和抑郁症。在美国，存在种族和社会经济（SES）差异 青光眼的患病率，视觉障碍和眼科护理利用率。但是，我们不知道这些差异是否 导致不同群体之间与视力和健康相关的结果差异。此外，虽然是 知道老年人的脆弱对发病率，死亡率和医疗保健成本具有影响， 青光眼老年人的脆弱与医疗保健利用和结果之间的关系尚未 探索。我们假设在使用眼保健服务上存在可检测到的差异，随后存在 基于种族和SES的青光眼老年人的视力和健康相关结果。我们进一步 假设具有较高脆弱得分和更多合并症的老年人使用眼部护理的可能性较小 服务将带来较差的视力和与健康相关的结果。为了解决这些假设， 从2014 - 2016年开始，我们将分析5％的Medicare受益人样本的现有数据。我们将组装 一群青光眼患者以及匹配的对照组。我们的分析旨在回答3 具体目的：1）基于种族的较老青光眼患者的眼神使用差异，SES 而且脆弱，社会人口统计学特征与脆弱之间是否存在相互作用？ 2）是青光眼 基于种族，SES和脆弱的弱势群体的患者更有可能感到不利 与视觉相关的结果？最后3）在健康利用和不利结果上存在差异 青光眼患者根据他们的种族和SES？我们假设青光眼对总体的影响 发病率和功能分布不均，脆弱的人群具有更大的风险或健康状况不佳 结果。这里概述的研究将提高我们对复杂因素相互作用的理解 导致青光眼护理和结果的差异。这项研究将使我们能够确定护理中的差距 在弱势群体中，并确定可能的干预领域。