Barriers to care for chronically ill vulnerable children

照顾患有慢性病的弱势儿童的障碍

• 批准号: 6480945
• 负责人: MICHAEL SEID
• 金额: $ 9.9万
• 依托单位: RADY CHILDREN'S HOSPITAL - SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-03-01 至 2004-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6480945
• 关键词: child (0-11); children; health care quality; health care service availability; health care service evaluation; health care service utilization; human subject; interview; pediatrics; quality of life; questionnaires; racial /ethnic difference

DESCRIPTION (APPLICATION ABSTRACT): Timely receipt of quality health care is important to the health of America?s children and even more so for children with special needs (CSHCN). However, for children in general and for CSHCN, disparities across vulnerability factors, such as race/ethnicity, SES, and language ability exist in relation to health care access, utilization, experiences, and outcomes. Our conceptual model posits that 1) vulnerability factors are associated with barriers to care, 2) these barriers to care affect access to, use of, and experiences of care, and 3) these barriers to care explain part of the observed health disparities. Developing a measure of barriers to care is a first step in testing this model. The main objective of the proposed research is to identify and measure modifiable barriers to care that affect the link between vulnerability factors, on the one hand, and health care structures, processes, and outcomes for CSHCN on the other. The specific aim of the proposed research is to develop and test a barriers to care questionnaire in English and Spanish. This will be accomplished using focus groups, cognitive interviews, and field testing in an existing sample of vulnerable CSHCN. The proposed research contributes new knowledge, specifically in the conceptualization and operationalization of the construct of barriers to care. Previous research has tended to view barriers to care as unidimensional, has tended to focus on barriers? impact on only one aspect of the health care process, and has tended to view SES and race/ethnicity as explanatory variables. The conceptualization of barriers to care as a multidimensional construct, as potentially impacting children?s health care at several points in the care process, and as distinct from, yet related to SES and race/ethnicity engenders a more robust, practical, and actionable understanding of the construct of barriers to care. A practical, reliable, and valid measure of barriers to care will be useful to many stakeholders in pediatric health care. Such a measure will support consumer choice by giving voice to patients? and parents? experiences with the care system. It will enhance accountability by giving providers and policymakers a tool for comparison and benchmarking. It will spur quality improvement by providing researchers and health care decision-makers a foundation for developing empirically-based interventions to improve the HRQL of vulnerable children. In this way, the proposed research could play a part in contributing to the nation?s goal of eliminating health disparities as described in the Public Health Service?s Healthy People 2010.

描述（应用摘要）：及时接收优质的医疗保健是 对美国的健康很重要，甚至对孩子来说更重要 有特殊需求（CSHCN）。但是，对于一般的儿童和CSHCN， 种族/种族，SES和诸如种族/民族等脆弱性因素之间的差异 语言能力与医疗保健获取，利用率有关， 经验和结果。我们的概念模型认为1）脆弱性 因素与护理障碍有关，2）这些护理障碍影响 获得，使用和经验的机会，以及3）这些护理的障碍 解释观察到的健康差异的一部分。制定衡量标准 护理障碍是测试该模型的第一步。主要目标 拟议的研究是识别和衡量可修改的护理障碍 一方面影响脆弱性因素之间的联系，一方面 CSHCN的医疗保健结构，过程和结果。这 拟议研究的具体目的是开发和测试障碍 护理英语和西班牙语的问卷。这将使用 现有样本中的焦点小组，认知访谈和现场测试 脆弱的CSHCN。拟议的研究贡献了新知识， 特别是在构造的概念化和运营中 护理障碍。以前的研究倾向于将护理的障碍视为 一维，倾向于专注于障碍吗？仅影响 医疗保健过程，并且倾向于将SES和种族/种族视为 解释变量。护理障碍的概念化 多维结构，可能会影响儿童的医疗保健 护理过程中的几个点，与SES和种族/种族有关，与种族/种族有关，使得更强大，实用和可行 了解护理障碍的结构。一个实用，可靠的， 有效的护理障碍衡量对许多利益相关者在 小儿保健。这样的措施将通过给予消费者选择 对患者的声音？和父母？护理系统的经验。会 通过为提供者和政策制定者提供一种工具来提高问责制 比较和基准测试。它将通过提供刺激质量的提高 研究人员和医疗保健决策者是发展的基础 基于经验的干预措施，以改善脆弱儿童的HRQL。 这样，拟议的研究可以在为 民族的目标是消除公众的健康差异 卫生服务2010。