Neighborhood transportation vulnerability and geographic patterns of diabetes-related limb loss

社区交通脆弱性和糖尿病相关肢体丧失的地理模式

• 批准号: 10539547
• 负责人: Howard H Chang
• 金额: $ 19.52万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-09 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10539547
• 关键词: Accounting; Address; Adult; Age; Ambulatory Care; Ambulatory Surgical Procedures; Amputation; Appointment; Area; Caring; Censuses; Chronic Disease; Clinic; Clinical; Code; Complications of Diabetes Mellitus; County; Data; Data Sources; Databases; Development; Diabetes Mellitus; Diabetic Foot Ulcer; Disease; Disease Outcome; Disease model; Electronic Health Record; Emergency department visit; End stage renal failure; Epidemiology; Ethnic Origin; Face; Feasibility Studies; Geographic Information Systems; Geography; Goals; Health; Health Care Costs; Health Insurance; Health Services Accessibility; Health care facility; Health system; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Hyperglycemia; Incidence; Insurance; Insurance Coverage; Intervention; Knowledge; Link; Location; Low income; Lower Extremity; Maps; Measures; Mediator of activation protein; Medical; Medical Records; Minor; Minority Groups; Modeling; Modification; Multi-Hospital Systems; Myocardial Infarction; National Institute on Minority Health and Health Disparities; Neighborhoods; Outcome; Outpatients; Patients; Pattern; Persons; Policies; Population Study; Prevalence; Provider; Public Hospitals; Race; Records; Research; Resources; Services; Stroke; Surveys; System; Transportation; Transportation of Patients; Ulcer; United States; Visit; barrier to care; base; built environment; cost; data resource; diabetes control; economic determinant; experience; health care availability; health care disparity; health care service utilization; hospital bed; limb loss; patient population; people of color; primary outcome; racial minority population; secondary outcome; sex; social; social health determinants; socioeconomics; spatial epidemiology; telehealth; transportation access; wound care

Transportation is paramount to health care access and minority populations face disproportionate transportation barriers in the United States (US). Health insurance coverage expansion has been the focus to achieve equitable health care in the US, but insurance alone does not guarantee access to care unless patients and providers can interact. Sixty percent of adults in the US have ≥1 chronic disease and current models of chronic disease care require frequent and ongoing contacts between patients and healthcare systems. Despite the advent of telehealth, most patient-provider interactions require patient transportation to a healthcare facility. US national-level surveys estimate 5.8 million people missed a health care appointment in 2017 due to transportation barriers and people of color face bigger transportation barriers to care. Our goal is to investigate the associations between “transportation vulnerability” and chronic disease outcomes at the neighborhood-level and to measure how race/ethnicity, sex, and age modify the magnitude of these associations using diabetic foot ulcers (DFUs) as a chronic disease model. “Transportation vulnerability” can arise from a combination of lacking transportation resources in an area, and from poor linkage between these resources and healthcare locations. Population-based studies linking transportation vulnerability to health outcomes are lacking. We choose DFU as model because they are a devastating diabetes complication preceding most of the 100,000 diabetes-related lower extremity amputations performed yearly in US. Low- income and racial minority groups experience higher burdens of DFUs and amputations. Importantly, the progression from ulceration to amputation is preventable with adequate outpatient care and DFUs have a clear poor outcome definition in the form of limb loss. Supported by a feasibility study, we will begin to fill this knowledge gap in this exploratory study by estimating the associations between transportation vulnerability and DFU outcomes using Georgia state-wide hospital billing databases, 2016-2020 (aim 1) and detailed patient- level records of two Atlanta-based large health systems, 2016-2021 (aim 2). This offers a unique opportunity to assess robustness of our findings from these two data sources with different advantages. Our research team has clinical expertise in DFUs, as well as chronic disease epidemiology, geographic information systems, and spatial epidemiology. This study is in line with the NIMHD research model by examining the intersection of the built environment and health care systems on health outcomes. Once in place, the framework developed will be extended to investigate the associations of transportation vulnerability and major diabetes complications (myocardial infarction, stroke, end-stage renal disease, and hyperglycemic crisis in addition to amputations) at a national-level. Our long-term goal is to develop a neighborhood-level US transportation vulnerability map to inform local interventions (e.g., allocation of non-emergency medical transportation services) and regional policies (e.g., development and improvement of public transit) to close disparities in healthcare access.

运输对医疗保健的机会至关重要，少数群体面临不相称的 美国的运输障碍（美国）。健康保险范围扩展一直是 在美国实现公平的医疗保健，但仅保险就不能保证获得护理 患者和提供者可以互动。美国有60％的成年人患有≥1种慢性疾病和当前 慢性疾病护理的模型需要经常进行患者与医疗保健之间的持续接触 系统。尽管有远程医疗的冒险，但大多数患者提供互动都需要患者运输到 医疗机构。美国国家一级调查估计有580万人错过了预约医疗保健 2017年由于运输障碍和有色人种面临更大的运输障碍。我们的目标是 调查“运输脆弱性”与慢性疾病结局之间的关联 邻居级别，以衡量种族/种族，性别和年龄如何修改这些大小 使用糖尿病足溃疡（DFU）作为慢性疾病模型的关联。 “运输脆弱性”可以 是由于一个地区缺乏运输资源的结合以及这些之间的不良联系 资源和医疗保健地点。将运输脆弱性与健康联系起来的基于人群的研究 缺乏结果。我们选择DFU作为模型，因为它们是毁灭性的糖尿病并发症 在美国每年在美国每年进行的100,000个与糖尿病有关的下肢截肢术中的大多数。低的- 收入和种族少数群体群体经历了更高的DFU和截肢的伯恩斯。重要的是， 通过足够的门诊护理可以预防从溃疡到截肢的发展，DFU具有清晰的 肢体损失形式的结果定义不佳。在可行性研究的支持下，我们将开始填写 通过估计运输脆弱性与 DFU结局使用佐治亚州范围内的医院计费数据库，2016 - 2020年（AIM 1）和详细的患者 - 基于亚特兰大的两个大型卫生系统的水平记录，2016 - 2021年（AIM 2）。这提供了一个独特的机会 从这两个数据源中评估我们发现的鲁棒性，具有不同的优势。我们的研究团队 在DFU以及慢性疾病流行病学，地理信息系统和 空间流行病学。这项研究与NIMHD研究模型一致 建立有关健康结果的环境和保健系统。一旦到位，就开发了框架 扩展以调查运输脆弱性和主要糖尿病并发症的关联 （心肌梗死，中风，终末期肾病和高血糖危机除截肢外） 国家一级。我们的长期目标是将邻里级的美国运输漏洞图开发到 告知当地干预措施（例如，非紧急医疗运输服务的分配）和区域性 政策（例如，公共交通的发展和改进），以弥补医疗保健访问的差异。