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

基本信息

批准号：
8865514
负责人：
Miriam Ryvicker
金额：
$ 10.9万
依托单位：
VISITING NURSE SERVICE OF NEW YORK
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-30 至 2016-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8865514
关键词：
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 Emergency department visit 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 built environment 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

项目摘要

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.

项目摘要/摘要老年人生活与晚期差异的社区特征之间的关联在慢性疾病中，研究领域已成为迅速增长的研究。对于低收入和少数民族患有慢性疾病的长者，获得的差异和护理质量会导致差异疾病。关于慢性病的研究还强调了医师监督不足的联系，可能预防的住院和健康状况不佳。但是，对中的方式知之甚少哪些邻里环境因素 - 除地方医疗服务以外的地方 - 告知城市年龄较大患有慢性疾病的成年人使用医师服务来管理自己的健康。这项研究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，公开访问过境），使用医师服务以及可预防的住院和急诊室访问居住在纽约市的老年人，长期患病的医疗保险受益人。具体而言，该研究的目的是： 1）检查邻里建筑环境与医师服务使用之间的关联城市，长期生病的老年人； 2）确定建筑环境的变化是否有可能影响可预防的住院和急诊室就诊；和 3）通过应用：（i）替代建模技术来重新评估目标1和2的发现；（ii）测试内生性，以解决患者对具有不同特征不同的社区的潜在分类基于服务使用和结果。该研究将基于对NYC居住Medicare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面积联系起来 - 来自其他来源的级别数据。分析将重点关注充血性心力衰竭和糖尿病的患者 - 两名可预防住院的主要贡献者。这项研究将洞悉影响慢性病护理质量的临床，社会，经济和环境因素以及最终，适用于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奖项期间扩展候选人的培训，包括高级方法论流行病学和卫生经济学培训。培训和研究活动将为该奖项后期的R01申请。这项研究的发现和未来的研究最终将应用于制定有效的干预措施，以改善卧床的获取，连续性和质量照顾生活在服务不足的社区中的慢性长者，然后减轻晚期健康差异。