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.

交通对于获得医疗保健至关重要，少数族裔人口面临着不成比例的问题 美国（US）的交通运输一直是医疗保险覆盖范围扩大的重点障碍。 在美国实现公平的医疗保健，但仅靠保险并不能保证获得医疗服务，除非 患者和提供者可以互动。60% 的美国成年人患有 ≥1 种慢性疾病并且当前患有这种疾病。 慢性病护理模式需要患者和医疗保健人员之间频繁且持续的接触 尽管出现了远程医疗系统，但大多数患者与提供者之间的互动都需要将患者运送到医疗机构。 美国国家级医疗机构调查估计，2019 年有 580 万人错过了医疗保健预约。 2017年由于交通障碍，有色人种面临更大的交通障碍，我们的目标是。 调查“交通脆弱性”与慢性病结果之间的关联 社区层面，并衡量种族/民族、性别和年龄如何改变这些影响的程度 使用糖尿病足溃疡（DFU）作为慢性疾病模型的协会可以。 是由于某个地区缺乏资源的交通组合以及这些交通之间的联系不良而产生的 将交通脆弱性与健康联系起来的基于人群的研究。 我们选择 DFU 作为模型，因为它们是一种毁灭性的糖尿病并发症。 在美国每年进行 100,000 例与糖尿病相关的下肢截肢手术中的大部分。 收入和种族少数群体承受着更高的 DFU 和截肢负担。 通过充分的门诊护理，从溃疡发展到截肢是可以预防的，并且 DFU 具有明确的 在可行性研究的支持下，我们将开始填补这一问题。 本探索性研究中的知识差距通过估计交通脆弱性与 使用 2016-2020 年佐治亚州范围内的医院计费数据库（目标 1）和详细的患者数据得出 DFU 结果 2016-2021 年亚特兰大两个大型卫生系统的水平记录（目标 2）。 我们的研究团队从这两个具有不同优势的数据源评估我们研究结果的稳健性。 拥有 DFU 以及慢性病流行病学、地理信息系统和 本研究通过检验空间流行病学的交叉点，符合 NIMHD 研究模型。 一旦到位，制定的框架将建立在健康成果基础上的环境和医疗保健系统。 扩展到调查交通脆弱性和主要糖尿病并发症的关联 （心肌梗塞、中风、终末期肾病和高血糖危象以及截肢） 我们的长期目标是制定一个社区级的美国交通脆弱性地图，以 告知当地干预措施（例如，分配非紧急医疗运输服务）和区域 旨在缩小医疗保健获取差距的政策（例如，发展和改善公共交通）。