Disparities in quality of healthcare affect utilization

医疗保健质量的差异影响利用率

• 批准号: 7036927
• 负责人: David C Brousseau
• 金额: $ 13.21万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-03-02 至 2011-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7036927
• 关键词: Medicare /Medicaid; behavioral /social science research tag; child health care personnel; choice; clinical research; decision making; emergency health services; health care cost /financing; health care quality; health care service evaluation; health care service utilization; health disparity; health services research tag; health surveys; human data; human subject; interview; medical records; outcomes research; parents; patient care personnel attitude; patient care personnel relations; patient oriented research; pediatrics; perception; primary care physician; statistics /biometry

DESCRIPTION (provided by applicant): There are over 22 million emergency department (ED) visits each year by children, and approximately 50% of these visits are for non-urgent conditions. Non-urgent ED visits are associated with overcrowding of the ED, increased cost to the healthcare system, and fragmented care of the child. ED utilization is related to the lack of a primary care provider, but 90% of children presenting to the ED have a primary care provider. To date, there have been no studies evaluating the effect of the parental perceived quality of primary care on subsequent utilization of ED services. As the parent makes the decision whether to seek care from the primary care provider or in the ED, it is critical to understand the parent perspective on the care their child receives from the primary care provider and its relationship to ED utilization. The two overall goals of this proposal are: 1) using large databases, to determine the ability of parental perceived quality of care to predict subsequent ED utilization; and 2) using qualitative methods, to further define the reasons for non-urgent ED utilization from the perspective of both the parent and the primary care provider. By carrying out these goals, and undertaking a structured set of career development activities, the candidate will become an expert in child health services utilization. The candidate will develop skills in analyzing complex survey samples, and will learn to analyze Medicaid claims data. He will use the information learned from these sources to develop and then conduct focused interviews with parents of children who present to the ED with non-urgent conditions and the primary care providers of those children. Completion and analysis of these interviews will enhance the candidate's skills in the use of mixed methods. The improved understanding of the choices parents make when deciding to seek care in the ED for their children will lead to the development of an intervention to be tested with subsequent R01 funding.

描述（由申请人提供）：每年有超过 2200 万名儿童到急诊室 (ED) 就诊，其中大约 50% 是因为非紧急情况。非紧急急诊就诊与急诊过度拥挤、医疗保健系统成本增加以及儿童护理分散有关。急诊室的利用率与缺乏初级保健提供者有关，但 90% 到急诊室就诊的儿童都有初级保健提供者。迄今为止，还没有研究评估父母对初级保健的感知质量对后续使用急诊服务的影响。当家长决定是向初级保健提供者还是去急诊室寻求护理时，了解家长对孩子从初级保健提供者那里接受的护理的看法及其与急诊室利用的关系至关重要。 该提案的两个总体目标是：1）使用大型数据库，确定父母感知的护理质量预测后续急诊室利用率的能力； 2) 使用定性方法，从家长和初级保健提供者的角度进一步明确非紧急急诊室使用的原因。通过实现这些目标并开展一系列结构化的职业发展活动，候选人将成为儿童健康服务利用方面的专家。候选人将培养分析复杂调查样本的技能，并将学习分析医疗补助索赔数据。他将利用从这些来源获得的信息，对向急诊科就诊的非紧急情况儿童的家长以及这些儿童的初级保健提供者进行重点访谈。完成和分析这些面试将提高候选人使用混合方法的技能。更好地了解父母在决定为孩子去急诊室寻求护理时所做的选择，将导致制定一项干预措施，并用随后的 R01 资金进行测试。