Disparities in Quality Healthcare Among Childhood Cancer Survivors: Role of Medicaid

儿童癌症幸存者的医疗质量差异：医疗补助的作用

基本信息

批准号：
10722895
负责人：
Xu Ji
金额：
$ 13.11万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-21 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10722895
关键词：
Address Adult Adverse effects Affect Affordable Care Act Age Automobile Driving Award COVID-19 pandemic Cancer Center Cancer Survivor Cancer Survivorship Caring Censuses Characteristics Childhood Childhood Cancer Survivor Study Chronic Chronic Disease Clinical Data Communities Cost Sharing Cross-Sectional Studies Data Detection Discrimination Disease Disparity Drops Early treatment Enrollment Ensure Equity Ethnic Origin Face Financial Hardship Foundations Future Goals Health Healthcare Impaired cognition Improve Access Individual Institution Insurance Insurance Coverage International Intervention Interview Knowledge Late Effects Lead Leadership Link Low income Malignant Childhood Neoplasm Malignant Neoplasms Measurable Measures Medicaid Mentorship Methods Modeling National Institute on Minority Health and Health Disparities Outcome Participant Patient Care Patients Pediatric Oncology Policies Population Qualitative Methods Quality of Care Quality of life Race Rare Diseases Recording of previous events Reduce health disparities Research Research Methodology Research Personnel Research Priority Role Scientist Services Societies Socioeconomic Status Source Structure Survey Methodology Surveys Survivors System Training Underserved Population United States Validation Work beneficiary cancer therapy care coordination care delivery care providers career childhood cancer survivor clinical care cohort design ethnic minority experience follow-up hands-on learning health care disparity health care quality health disparity health literacy high risk implementation science improved learning strategy low socioeconomic status medical specialties minority health multidisciplinary post-pandemic pre-pandemic programs public health insurance racial health disparity racial minority recruit rural disparities rural dwellers rurality satisfaction sex sex disparity skills sociodemographic group socioeconomics tool urban disparity voltage

Address Adult Adverse effects Affect Affordable Care Act Age Automobile Driving Award COVID-19 pandemic Cancer Center Cancer Survivor Cancer Survivorship Caring Censuses Characteristics Childhood Childhood Cancer Survivor Study Chronic Chronic Disease Clinical Data Communities Cost Sharing Cross-Sectional Studies Data Detection Discrimination Disease Disparity Drops Early treatment Enrollment Ensure Equity Ethnic Origin Face Financial Hardship Foundations Future Goals Health Healthcare Impaired cognition Improve Access Individual Institution Insurance Insurance Coverage International Intervention Interview Knowledge Late Effects Lead Leadership Link Low income Malignant Childhood Neoplasm Malignant Neoplasms Measurable Measures Medicaid Mentorship Methods Modeling National Institute on Minority Health and Health Disparities Outcome Participant Patient Care Patients Pediatric Oncology Policies Population Qualitative Methods Quality of Care Quality of life Race Rare Diseases Recording of previous events Reduce health disparities Research Research Methodology Research Personnel Research Priority Role Scientist Services Societies Socioeconomic Status Source Structure Survey Methodology Surveys Survivors System Training Underserved Population United States Validation Work beneficiary cancer therapy care coordination care delivery care providers career childhood cancer survivor clinical care cohort design ethnic minority experience follow-up hands-on learning health care disparity health care quality health disparity health literacy high risk implementation science improved learning strategy low socioeconomic status medical specialties minority health multidisciplinary post-pandemic pre-pandemic programs public health insurance racial health disparity racial minority recruit rural disparities rural dwellers rurality satisfaction sex sex disparity skills sociodemographic group socioeconomics tool urban disparity voltage

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项目摘要

PROJECT SUMMARY/ABSTRACT Survivors of childhood cancer require life-long healthcare to improve quality of life and health. However, the majority of adult survivors of childhood cancer, including those with public health insurance (primarily Medicaid), lack long-term healthcare. There are crucial gaps in our current understanding of disparities in patient care and the modifiable factors that create and perpetuate disparities in care among childhood cancer survivors in the Medicaid system. This study will use qualitative and survey research methods to systematically assess survivor experience of care in the Medicaid system and determine sources of disparities affecting care experience among adult survivors of childhood cancer. We anticipate contacting for potential recruitment a total of 2,700 adult survivors insured with Medicaid from the Childhood Cancer Survivor Study (CCSS), including: 20 survivors for qualitative survivor interviews (Aim 1), among whom 8 survivors will participate in a Delphi panel (Aim 2); 144 survivors for a pilot survey (Aim 2); and 2,536 survivors for an expanded survey (Aim 3). For Aim 1, we will also include 10 stakeholder participants (care providers and financial navigators) from CCSS participating institutions for qualitative stakeholder interviews. The specific aims are as follows. Aim 1: Use qualitative methods to explore multi-level barriers to quality healthcare for adult survivors of childhood cancer in the Medicaid system. Aim 2: Develop and validate a survey to quantify survivor experiences with the Medicaid system. Aim 3: Assess racial/ethnic, socioeconomic, rural-urban, and sex disparities in survivor experiences with insurance and healthcare in Medicaid, and how disparities are related to survivor-, community-, and state-level characteristics. The focus of this study aligns with the NIMHD’s research priority to understand and reduce health disparities by race/ethnicity, socioeconomic status, rurality, and sex. Data gained from this study will form the foundation for an R01 proposal to survey state-specific cancer survivor cohorts, with the goal of informing interventions that promote equitable, high-quality care based on state Medicaid program rules. The candidate’s long-term career goal is to become an independent scientist with a research program focused on addressing disparities in health and healthcare after childhood cancer. Under the mentorship of international experts in health disparities/minority health and cancer survivorship, the candidate will accomplish her short-term goals to 1) develop expertise in health disparities and implementation science, 2) acquire qualitative and survey research skills, 3) understand patient experience in pediatric oncology and cancer survivorship, and 4) improve research leadership and management skills to complete transition to independence. The integrated training plan includes a mix of didactic courses, hands-on learning activities, and focused multidisciplinary mentorship that will advance the candidate’s research skills and ensure her transition to a fully independent investigator.

项目摘要/摘要儿童癌症的幸存者需要终身医疗保健，以改善生活质量和健康。但是，大多数儿童癌症的成人生存，包括公共卫生保险的癌症（主要是医疗补助），缺乏长期医疗保健。我们目前对差异的理解存在关键的差距患者护理和在儿童癌症中产生和永久分布的可修改因素医疗补助系统中的幸存者。这项研究将使用定性和调查研究方法进行系统地评估医疗补助系统中的幸存者护理经验，并确定影响护理的分配来源在儿童癌症的成人生存中的经验。我们预计接触潜在招募儿童癌症幸存者研究（CCSS）的医疗补助保险的总共2700名成年人幸存者，包括：20个定性冲浪者访谈的冲浪者（AIM 1），其中8个冲浪者将参加 Delphi面板（AIM 2）； 144个飞行员调查的冲浪者（AIM 2）；和2,536个冲浪者进行扩展调查（AIM 3）。对于AIM 1，我们还将包括10位利益相关者参与者（护理提供者和财务导航员） CCSS参与机构进行定性利益相关者访谈。具体目标如下。目标1：使用定性方法来探索成人童年成人生存的高质量医疗保健的多层次障碍医疗补助系统中的癌症。目标2：开发和验证调查以量化与医疗补助系统。目标3：评估幸存者中的种族/族裔，社会经济，城市和性别分布在医疗补助中有保险和医疗保健的经验，以及差异与幸存者的关系如何社区和州级特征。这项研究的重点符合NIMHD的研究优先事项通过种族/种族，社会经济地位，粗糙性和性别来理解和减少健康差异。数据从这项研究中获得的将构成R01调查州特异性癌症幸存者的提议的基础同伙，目的是告知干预措施，以促进基于状态的公平，高质量的护理医疗补助计划规则。候选人的长期职业目标是成为一名独立科学家研究计划的重点是解决儿童癌后健康和医疗保健方面的差异。在候选人的卫生分配/少数民族健康与癌症生存专家的国际专家将实现她的短期目标至1）发展健康分布和实施科学方面的专业知识， 2）获得定性和调查研究技能，3）了解儿科肿瘤学和癌症生存和4）提高研究领导和管理技能，以完成过渡到独立。综合培训计划包括教学课程，动手学习活动和专注于多学科的指导，将提高候选人的研究技能并确保她的过渡给完全独立的研究者。