Race and Medicare-Medicaid Dual Enrollment Disparities in Access to Quality and Intensity of Post-Acute Rehabilitation Care and Health Outcomes in Patients with Stroke

种族和医疗保险-医疗补助双重注册在中风患者获得急性后康复护理和健康结果的质量和强度方面存在差异

• 批准号: 10528690
• 负责人: Amit Kumar
• 金额: $ 0.2万
• 依托单位: NORTHERN ARIZONA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-11 至 2022-12-16
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10528690
• 关键词: Accounting; Acute; Address; Admission activity; Adult; Area; Assessment tool; Caregivers; Caring; Characteristics; Clinical; Communities; Data; Data Collection; Decision Aid; Decision Making; Development; Diabetes Mellitus; Discharge Plannings; Dose; Dual Enrollment; Ethnic Origin; Evaluation; Focus Groups; Goals; Health; Health Services; Health care facility; Hospitalization; Hospitals; Hypertension; Improve Access; Individual; Inpatients; Lead; Length of Stay; Measures; Medicare; Medicare claim; Medicare/Medicaid; Methods; Occupational Therapy; Outcome; Pathway interactions; Patient-Centered Care; Patient-Focused Outcomes; Patients; Perception; Physical therapy; Population; Process; Provider; Proxy; Qualitative Methods; Quality of Care; Race; Recovery; Recovery of Function; Rehabilitation therapy; Research; Sampling; Scientific Advances and Accomplishments; Selection Bias; Severities; Speech Therapy; Stroke; Time; Underserved Population; United States; United States Centers for Medicare and Medicaid Services; Work; acute care; acute stroke; base; beneficiary; care outcomes; cohort; cost; design; dual eligible; ethnic minority; functional gain; functional status; health care delivery; health disparity; hospital readmission; improved; indexing; low socioeconomic status; post stroke; primary outcome; provider factors; racial and ethnic; racial disparity; racial minority; rehabilitation service; rehabilitative care; service providers; stroke outcome; stroke patient; tool

PROJECT SUMMARY Racial disparity in stroke-related care remains among the most compelling health service concerns in the United States. Stroke patients account for about 20% of all inpatient rehabilitation facility (IRF) admissions. However, there is limited research to date exploring patient-centered outcomes associated with the quality and intensity of IRF-based rehabilitation services among stroke patients who are racial/ethnic minorities and are dual eligible for Medicare and Medicaid. Our proposal uses an integrative mixed methods design to study how individual- and provider-level factors contribute to disparities in IRF quality rating and amount of therapy, and subsequently, the combined effect of the two on patient health outcomes. The qualitative aim will identify facilitators and barriers to IRF selection among racial/ethnic minorities and those with dual eligiblility after stroke and the impact of the selection of quality IRFs on patient perceptions of IRF quality of care. This study will use 100% Medicare claims and assessment data (2017-2022), and perspectives from patients/caregivers, hospital discharge planners, and rehabilitation clinicians from different regions to understand selection processes of IRF and outcomes. We will utilize the Medicare Inpatient Standard Analytical File, Beneficiary Summary, Inpatient Rehabilitation Facilities Patient Assessment Instrument, Provider of Service, and publicly available IRF Medicare compare data. Patients with ‘index stroke’ admitted directly to IRFs from acute hospitals will serve as our primary cohort. For the first three aims, a) change in functional status, b) 30-day hospital readmission, and c) community discharge will serve as primary outcomes, adjusting for patient-, hospital-, and market-level characteristics. For the fourth, qualitative aim, patient perception of IRF quality and perceived functional recovery will be primary dependent variables for assessing the impact of disparities in rehabilitation care.

项目概要 中风相关护理中的种族差异仍然是美国最引人注目的卫生服务问题之一 各州中风患者约占所有住院康复机构 (IRF) 入院患者的 20%。 迄今为止，探索以患者为中心的结果与治疗质量和强度相关的研究还很有限。 为少数族裔且符合双重资格的中风患者提供基于 IRF 的康复服务 我们的建议使用综合混合方法设计来研究个人和医疗补助。 提供者层面的因素导致 IRF 质量评级和治疗量的差异，随后， 两者对患者健康结果的综合影响。定性目标将确定促进因素和障碍。 种族/族裔少数群体和中风后具有双重资格的人中 IRF 选择的影响以及 根据患者对 IRF 护理质量的看法来选择优质 IRF。 本研究将使用 100% 医疗保险索赔和评估数据（2017-2022 年）以及来自 来自不同地区的患者/护理人员、出院计划人员和康复士兵了解 我们将利用 Medicare 住院患者标准分析文件的选择流程， 受益人摘要、住院康复设施患者评估工具、服务提供者以及 公开的 IRF 医疗保险比较数据。患有“指数中风”的患者因急性发作而直接入住 IRF。 医院将作为我们的主要队列，实现前三个目标：a) 功能状态的改变，b) 30 天。 重新入院，以及 c) 社区出院将作为主要结果，根据患者、 第四个是定性目标，即患者对 IRF 质量和水平的看法。 感知的功能恢复将是评估差异影响的主要因变量 康复护理。