Regulatory Reforn and Angiography Disparties

监管改革和血管造影的分歧

• 批准号: 6924520
• 负责人: JOEL C CANTOR
• 金额: $ 23.17万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-01 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6924520
• 关键词: African American; Hispanic Americans; angiography; cardiovascular imaging /visualization; caucasian American; clinical research; data collection; health care quality; health care service availability; health care service utilization; health disparity; health services research tag; human subject; interview; mathematical model; medically underserved population; racial /ethnic difference

DESCRIPTION (provided by applicant): Beginning in 1996, New Jersey embarked on hospital regulatory reforms that addressed, among other goals, the long-standing problem of racial and ethnic disparities in use of cardiac angiography (CA). These reforms led to a doubling in the number of hospitals performing CA as well as state-monitoring of minority outreach and access activities for CA services at each hospital. This proposal builds on AHRQ-funded pilot studies to examine the effectiveness of this innovative policy. Specific aims are to: (1) determine whether the disparity between black and white CA utilization declined following implementation of NJ policies intended to expand access for minority patients, (2) evaluate how local health system characteristics may influence CA disparities and the pathways through which the NJ policy may have reduced these disparities; and (3) identify promising strategies for reducing CA disparities. Hispanic-white CA disparities will also be investigated. Quantitative modeling and qualitative analyses will be blended to evaluate CA disparity trends from 1993-2003 in contrast to trends in a non-reform state. Primary outcome measures are the white-black difference in age-sex adjusted CA rates in small areas and the volume and share of CA utilization by black patients at NJ hospitals that provided CA throughout the study period. Regression methods will be used to adjust for market area demographics and other factors. Hypotheses about the effects of changes in CA capacity and hospital competition will be tested. CA facilities that demonstrate higher-than-expected levels of service to black patients, based on regression models, will be selected for intensive case studies along with a set of matched comparison facilities that are not high performing. The case studies will be focused on the market areas of the selected facilities, and will include documentary review and semi-structured interviews of officials from the selected CA facilities, referring hospitals, community health centers and other players in the case markets. Research findings will be translated to the practice and policy community in the form of "best practices" and through feedback of hospital-specific CA disparity performance measures.

描述（由申请人提供）：从 1996 年开始，新泽西州开始进行医院监管改革，其目标之一是解决心脏血管造影 (CA) 使用方面长期存在的种族和民族差异问题。这些改革使得开展 CA 的医院数量增加了一倍，并且国家对每家医院的少数族裔外展和获取 CA 服务的活动进行了监督。该提案以 AHRQ 资助的试点研究为基础，旨在检验这一创新政策的有效性。具体目标是：(1) 确定在新泽西州实施旨在扩大少数族裔患者就诊机会的政策后，黑人和白人 CA 使用率之间的差距是否有所缩小，(2) 评估当地卫生系统特征如何影响 CA 差距以及影响 CA 差距的途径新泽西州的政策可能缩小了这些差距； (3) 确定减少 CA 差异的有前景的策略。西班牙裔白人 CA 差异也将受到调查。将结合定量建模和定性分析来评估 1993 年至 2003 年的 CA 差异趋势，并与非改革国家的趋势进行对比。主要结果指标是小区域内年龄性别调整后 CA 率的白人与黑人差异，以及在整个研究期间提供 CA 的新泽西州医院中黑人患者使用 CA 的数量和比例。将使用回归方法来调整市场区域人口统计数据和其他因素。有关 CA 能力变化和医院竞争影响的假设将得到检验。根据回归模型，向黑人患者提供的服务水平高于预期的 CA 机构将被选择进行深入的案例研究，同时还会选择一组表现不佳的匹配比较机构。案例研究将重点关注选定机构的市场领域，并将包括对选定 CA 机构、转诊医院、社区卫生中心和案例市场中其他参与者的官员进行文件审查和半结构化访谈。研究结果将以“最佳实践”的形式并通过医院特定的 CA 差异绩效衡量指标的反馈转化为实践和政策界。