Disparities in Post-Acute Rehabilitation Care

急性后康复护理的差异

基本信息

批准号：
7440563
负责人：
JANET Kues FREBURGER
金额：
$ 21.89万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-05-01 至 2010-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7440563
关键词：
Acute Address Affect Age American American Hospital Association Area Attitude Behavioral Model Belief Caregivers Caring Censuses Cessation of life Characteristics Communities Condition Count Data Data Analyses Databases Diagnosis Elderly woman Ethnic Origin Exploratory/Developmental Grant Foundations Future Gender Health Health Care Costs Health Personnel Healthcare Healthcare Systems Hip Fractures Home environment Hospitalization Hospitals Improve Access Income Individual Inpatients Institution Institutionalization Insurance Coverage Intermediate Care Facilities Intervention Long-Term Care Low income Marital Status Medicare Minority Nursing Homes Older Population Outcome Outpatients Patients Play Population Prospective Payment System Public Health Purpose Quality of life Race Regression Analysis Rehabilitation therapy Replacement Arthroplasty Reporting Research Resources Role Rural Series Severity of illness Sex Characteristics Skilled Nursing Facilities Socioeconomic Status Standards of Weights and Measures Stroke Subgroup Surveys Techniques Testing Underserved Population United States Agency for Healthcare Research and Quality Work base cohort functional disability health care quality health disparity improved income insurance racial difference socioeconomics therapy development

项目摘要

DESCRIPTION (provided by applicant): The broad long-term objective of this research is to inform the development of interventions that will improve access to, use of, and quality of post-acute rehabilitation care for underserved populations. The primary objective of the proposed study is to gain a more thorough and current understanding of disparities in the use of post-acute rehabilitation care following hip fracture, joint replacement, and stroke. This study proposes to pool and analyze state-specific hospital discharge data from four geographically and demographically diverse states (AZ, FL, NJ, WI). The hospital discharge data will be merged with data from the American Hospital Association Annual Survey database, the Area Resource File, and U.S. Census data. Descriptive, bivariate, and multivariable regression analyses for discrete outcomes, including multi-level analyses, will be conducted for each condition to achieve the following specific aims: 1) Describe the sociodemographic (race, ethnicity, age, gender, socioeconomic status) and geographic disparities (urban/rural, state) in the use of post-acute rehabilitation care. Through descriptive and bivariate analyses of the data, we will determine the extent to which use of post-acute rehabilitation care varies by each sociodemographic and geographic characteristic. 2) Determine the extent to which identified sociodemographic and geographic disparities are explained by other observed characteristics. Through a series of multivariable analyses examining individual and community-level characteristics associated with the use of post-acute rehabilitation care and through the use of decomposition techniques we will determine the extent to which the identified disparities are explained by other observed characteristics. More specifically, we will determine the extent to which the identified disparities are: a. confounded by other observed characteristics (e.g., insurance status and/or disease severity may explain some of the racial differences in use; marital status may explain some of the gender differences in use); b. moderated by other observed characteristics (e.g., disparities in use may differ for low income and high income minorities); c. explained by individual versus community-level characteristics (we hypothesize that both individual and community-level factors will explain differences in use); and d. unexplained by the characteristics examined in this study (we hypothesize that some of the identified differences in use will be unexplained). PUBLIC HEALTH RELEVANCE: Post-acute rehabilitation care is an effective and growing area of health care that has not been adequately investigated in regard to health care disparities. Identifying the extent to which disparities exist in post-acute rehabilitation care and determining underlying reasons for these disparities are necessary first steps in developing interventions to eliminate these disparities.

描述（由申请人提供）：本研究的广泛长期目标是为干预措施的制定提供信息，以改善服务不足人群的急性后康复护理的获取、使用和质量。拟议研究的主要目的是更全面、更及时地了解髋部骨折、关节置换和中风后急性后康复护理使用的差异。本研究拟汇集并分析来自四个地理和人口不同的州（亚利桑那州、佛罗里达州、新泽西州、威斯康星州）的特定州的出院数据。出院数据将与美国医院协会年度调查数据库、地区资源文件和美国人口普查数据合并。将对每种情况进行离散结果的描述性、双变量和多变量回归分析，包括多水平分析，以实现以下具体目标： 1) 描述使用急性后康复护理的社会人口统计（种族、民族、年龄、性别、社会经济地位）和地理差异（城市/农村、州）。通过对数据的描述性和双变量分析，我们将确定急性后康复护理的使用因每个社会人口统计和地理特征而异的程度。 2) 确定其他观察到的特征可以在多大程度上解释所确定的社会人口和地理差异。通过一系列多变量分析，检查与使用急性后康复护理相关的个人和社区层面的特征，并通过使用分解技术，我们将确定其他观察到的特征在多大程度上解释所识别的差异。更具体地说，我们将确定已识别差异的程度：被其他观察到的特征所混淆（例如，保险状况和/或疾病严重程度可以解释使用中的一些种族差异；婚姻状况可以解释使用中的一些性别差异）； b.受到其他观察到的特征的调节（例如，低收入和高收入少数群体的使用差异可能有所不同）； c.由个人与社区层面的特征来解释（我们假设个人和社区层面的因素都可以解释使用的差异）；和d。本研究中检查的特征无法解释（我们假设一些已识别的使用差异将无法解释）。公共卫生相关性：急性后康复护理是一个有效且不断增长的医疗保健领域，但尚未对医疗保健差异进行充分调查。确定急性后康复护理中存在差异的程度并确定这些差异的根本原因是制定干预措施以消除这些差异的必要的第一步。