Health Systems, Quality of Care, and Outcomes in SLE

SLE 的卫生系统、护理质量和结果

• 批准号: 8325473
• 负责人: EDWARD H YELIN
• 金额: $ 58.59万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-05 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8325473
• 关键词: Accounting; Adherence; Affect; Autoimmune Diseases; Biological Assay; Caring; Censuses; Characteristics; Communities; Cost Sharing; Data; Data Sources; Disadvantaged; Disease; Distal; Drug toxicity; Environment; Ethnic Origin; Fee-for-Service Plans; Funding; Genetic; Goals; Health; Health Insurance; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Insurance; Lupus; Managed Care; Marketing; Measures; Medical; Medicare/Medicaid; Monitor; Morbidity - disease rate; Nature; Neighborhoods; Outcome; Outcome Measure; Outcome Study; Participant; Persons; Physicians; Play; Preventive; Progress Reports; Provider; Publications; Quality Indicator; Quality of Care; Race; Research; Research Infrastructure; Research Personnel; Role; Socioeconomic Status; Source; Structure; Surveys; System; Systemic Lupus Erythematosus; Telephone Interviews; Testing; Time; Work; abstracting; adverse outcome; body system; care systems; cohort; cost; design; experience; health care service utilization; low socioeconomic status; meetings; payment; prospective; response; socioeconomics; success

DESCRIPTION (provided by applicant): Prior research has firmly established both that persons of lower socioeconomic status with systemic lupus erythematosus (SLE) experience poorer access to care, actual health care utilization, and outcomes due in part to the nature of their health insurance. The proposed project will assess the role that differences in quality of care play in explaining why persons with SLE from disadvantaged backgrounds have less access to care and poorer health outcomes. The project will draw upon the data from the Lupus Outcomes Study (LOS) to assess the effect of quality of care on SLE outcomes. The LOS currently includes 1,026 persons with SLE from a wide range of environments across the nation, most of whom have been followed for five years. The principal data in the LOS are data from medical charts and annual structured telephone interviews, supplemented by contextual data about the neighborhoods and medical markets of LOS participants from the Census and other publicly available data sources, matched to the survey responses by geocoding. The specific goals of the project are to: 1) describe the extent to which care for SLE adheres to measures of quality cross-sectionally and over time; 2) establish the relationship between quality of care and kind and extent of health care utilization; 3) document differences in quality of care by socioeconomic status, race/ethnicity, local communities, and the nature of medical markets; 4) establish the relationship among such features of the health care system as type of insurance (Medicaid, Medicare, or private), form of insurance (managed care or fee-for-service), and extent of cost sharing and quality of care, after taking personal SES and extent of health care infrastructure into account; and, 5) describe the role that differences in quality of care play in explaining outcome differences by SES, including traditional measures of outcome as well as costs. The project may help reduce disparities in access and outcomes by showing that adherence to standards for quality of care can redound to the disadvantaged with SLE either by assisting their physicians to provide such care or by spurring referral to high quality providers. PUBLIC HEALTH RELEVANCE: Systemic lupus erythematosus (SLE) is a severe autoimmune disease with a potential for significant morbidity due to impacts on many organ systems. Prior research has established that persons with SLE from lower socioeconomic backgrounds have poorer access to care and long-term outcomes. The proposed project will use a cohort of over 1,000 persons with SLE followed for up to ten years to determine the extent to which the poorer outcomes of those of low socioeconomic status is because they are less likely to receive health care that meets minimal criteria for quality. The project could help persons with SLE from low socioeconomic backgrounds by showing that referral to physicians providing high quality care will reduce disparities in outcomes.

描述（由申请人提供）：先前的研究已经牢固地确定了具有较低的社会经济地位的人，其系统性红斑狼疮（SLE）经历了较差的医疗服务，实际的医疗保健利用率和结果，部分原因是其健康保险的性质。拟议的项目将评估护理质量差异在解释为什么来自弱势背景的人的差异中的差异，而无法获得护理和较差的健康状况。该项目将利用狼疮结果研究（LOS）的数据来评估护理质量对SLE结果的影响。 LOS目前包括来自全国各地各种环境的1,026人，其中大多数已经遵循了五年。 LOS中的主要数据是医疗图表和年度结构化电话访谈的数据，并补充了有关LOS参与者的社区和医疗市场的上下文数据，来自人口普查和其他公开可用的数据源，与地理编码的调查响应相匹配。该项目的具体目标是：1）描述SLE遵守质量横截面和随着时间的衡量的程度； 2）建立护理质量与医疗保健利用范围之间的关系； 3）记录通过社会经济地位，种族/种族，当地社区和医疗市场本质的护理质量差异； 4）建立保险类型（医疗补助，医疗保险或私人），保险形式（托管护理或服务费用）以及成本共享和护理质量的程度，建立诸如保险类型（医疗补助，医疗保险或私人）之间的关系之间的关系；以及，5）描述在解释SES的结果差异（包括传统的结果措施和成本）中，在护理质量中差异的作用。该项目可以通过表明遵守护理质量标准的标准可以通过协助其医生提供这样的护理或激发向高质量提供者的转诊来帮助减少访问和结果的差异。公共卫生相关性：全身性红斑狼疮（SLE）是一种严重的自身免疫性疾病，由于对许多器官系统的影响，其可能出现明显的发病率。先前的研究已经确定，来自较低社会经济背景的SLE的人获得了护理和长期成果的机会。拟议的项目将使用1000多名SLE的人群，然后使用长达十年的时间，以确定社会经济地位低下的较差结果的程度是因为他们不太可能获得符合最小质量标准的医疗保健。该项目可以通过向提供高质量护理的医生的转诊来帮助来自低社会经济背景的SLE的人。