Built Environment and Health Care Use: Disparities Among Chronically Ill Elders

建筑环境和医疗保健使用：慢性病老年人之间的差异

• 批准号: 8334079
• 负责人: Miriam Ryvicker
• 金额: $ 13.03万
• 依托单位: VISITING NURSE SERVICE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8334079
• 关键词: Accident and Emergency department; Address; Age; Ambulatory Care; Area; Award; Caring; Characteristics; Chronic; Chronic Disease; Chronically Ill; Clinical; Communities; Comorbidity; Congestive Heart Failure; County; Data; Diabetes Mellitus; Diagnosis; Dimensions; Economic Factors; Economics; Elderly; Environment; Environmental Risk Factor; Epidemiology; Equation; Foundations; Frequencies; Goals; Health; Health Service Area; Health Services Accessibility; Healthcare; Hospitalization; Improve Access; Individual; Life; Link; Low income; Measures; Medicare; Mentored Research Scientist Development Award; Minority; Modeling; Neighborhoods; New York City; Outcome; Patients; Physicians; Provider; Quality of Care; Quality of life; Research; Research Activity; Sampling; Services; Socioeconomic Status; Sorting - Cell Movement; Source; Techniques; Testing; Time; Training; Training Activity; Transportation; Variant; Visit; Vulnerable Populations; Walking; base; beneficiary; burden of illness; demographics; effective intervention; geographic difference; health disparity; health economics; insight; longitudinal analysis; medical supply; prevent; racial and ethnic disparities; social; socioeconomics; therapy design

PROJECT SUMMARY/ABSTRACT Associations between characteristics of the neighborhoods in which older people live and late-life disparities in chronic illness have been the subject of a rapidly growing field of research. For low-income and minority elders with chronic illness, disparities in access to and quality of care contribute to disparities in the burden of illness. Research on chronic illness has also underscored the links between inadequate physician oversight, potentially preventable hospitalizations, and poor health outcomes. However, little is known about the ways in which neighborhood environmental factors - beyond local supply of medical services - inform how urban older adults with chronic illness use physician services to manage their health. This study addresses this gap by examining the relationships between neighborhood built environment (e.g. walk-ability, access to public transit), use of physician services, and preventable hospitalizations and emergency department visits among elderly, chronically ill Medicare beneficiaries who live in New York City. Specifically, the study aims to: 1) Examine associations between neighborhood built environment and physician service use among urban, chronically ill older adults; 2) Determine whether and to what extent variations in the built environment influence potentially preventable hospitalizations and emergency department visits; and 3) Reassess findings from Aims 1 and 2 by applying: (i) alternative modeling techniques; and (ii) tests of endogeneity to address the potential sorting of patients into neighborhoods with different characteristics based on service use and outcomes. The study will be based on longitudinal analysis of existing data on a sample of NYC-dwelling Medicare beneficiaries age 65 and older, linking individual characteristics and service use measures with small area- level data from other sources. Analyses will focus on patients with congestive heart failure and diabetes - two major contributors to preventable hospitalizations. This study will provide insight into the interdependence of clinical, social, economic, and environmental factors that influence quality of chronic illness care and, ultimately, quality of life, for older adults with multiple co-morbidities. The proposed research will apply and expand on the candidate's training throughout the K01 award period, including advanced methodological training in epidemiology and health economics. The training and research activities will lay the foundation for an R01 application in the later years of the award. Findings from this study and future research will ultimately be applied toward developing effective interventions to improve access to, continuity, and quality of ambulatory care for chronically ill elders living in underserved communities and, in turn, mitigate late-life health disparities.

项目概要/摘要 老年人居住的社区特征与晚年差异之间的关联 慢性病的治疗已成为快速发展的研究领域的主题。对于低收入和少数族裔 患有慢性疾病的老年人，获得护理的机会和质量的差异导致了负担的差异 疾病。对慢性病的研究也强调了医生监督不足、 可能可以预防的住院治疗和不良的健康结果。然而，人们对其中的方式知之甚少 除了当地医疗服务的供应之外，哪些社区环境因素影响着城市老年人的健康状况 患有慢性病的成年人使用医生服务来管理他们的健康。这项研究通过以下方式解决了这一差距 检查邻里建筑环境之间的关系（例如步行能力、公共设施的可达性） 交通）、使用医生服务以及可预防的住院和急诊就诊 居住在纽约市的老年、慢性病医疗保险受益人。具体来说，该研究旨在： 1) 检查社区建筑环境与医生服务使用之间的关联 城市中患有慢性病的老年人； 2) 确定建筑环境的变化是否以及在何种程度上产生潜在影响 可预防的住院治疗和急诊就诊；和 3) 通过应用以下方法重新评估目标 1 和 2 的结果： (i) 替代建模技术； (ii) 测试 内生性，以解决将患者分类到具有不同特征的社区的可能性 基于服务的使用和结果。 该研究将基于对纽约市居住医疗保险样本的现有数据的纵向分析 65 岁及以上的受益人，将个人特征和服务使用措施与小区域联系起来 来自其他来源的水平数据。分析将重点关注患有充血性心力衰竭和糖尿病的患者 - 两种 可预防的住院治疗的主要贡献者。这项研究将提供对相互依存关系的深入了解 影响慢性病护理质量的临床、社会、经济和环境因素， 最终，是患有多种合并症的老年人的生活质量。拟议的研究将适用并 在整个 K01 奖励期间扩大候选人的培训，包括先进的方法论 流行病学和卫生经济学培训。培训和研究活动将为 奖项后期几年的 R01 申请。这项研究和未来研究的结果最终将 用于制定有效的干预措施，以改善门诊服务的可及性、连续性和质量 照顾生活在服务匮乏社区的慢性病老年人，进而缩小晚年健康差距。