Understanding and Addressing Disparities in Primary Care: A National Mixed Methods Study

了解和解决初级保健方面的差异：一项全国混合方法研究

基本信息

批准号：
10777104
负责人：
ELLIOTT S FISHER
金额：
$ 82.95万
依托单位：
DARTMOUTH COLLEGE
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：
2023-09-30 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10777104
关键词：
Academy Address Adoption Age Alzheimer&apos s disease related dementia COVID-19 COVID-19 pandemic Caring Case Study Cessation of life Chronic Chronic Disease Communities County Cross-Sectional Studies Data Data Set Diagnosis Disease Progression Disparity Economics Elderly Ensure Fee-for-Service Plans Foundations Funding Goals Health Health Services Accessibility Health system Healthcare Healthcare Systems Hospitalization Incidence Inequity Intervention Interview Investigation Life Expectancy Link Low income Measures Medicaid Medicare Medicare claim Medicine Methods Minority Minority Groups Names Neighborhood Health Center Outcome Ownership Physicians Play Policies Policy Maker Population Prevention Primary Care Primary Care Physician Process Qualitative Research Quality of Care Recommendation Reduce health disparities Reporting Research Project Grants Resources Respondent Risk Role Rural Sampling Site Surveys System Testing Travel United States United States Agency for Healthcare Research and Quality United States National Institutes of Health Update Wood material Work beneficiary care outcomes cohort contextual factors data resource disability disparity reduction evidence base falls health determinants health disparity improve minority health improved informant insight minority health disparity modifiable risk mortality practice factors premature prevent primary care practice primary care provider residential segregation rural residence safety net social trend

项目摘要

ABSTRACT Disparities in health within the U.S. are pervasive and, for some populations, widening. High-quality primary care plays an important role in the prevention, diagnosis and management of the many chronic health conditions that contribute to health disparities among older adults. Primary care in the U.S., however, is threatened. Even before COVID-19, the per-capita supply of primary care physicians was falling and varied dramatically by county, threatening rural and other less-advantaged communities. Little is known about how access to high-quality primary care has changed in recent years—including changes in access associated with the COVID-19 pandemic—or about the policy-, system-, or practice-level factors that are associated with better quality of primary care for older adults. These gaps in understanding have hindered our ability, as a nation, to provide the best care to older adults. This project will address this need by drawing on a unique national dataset that includes annual information on the ownership and staffing of all U.S. primary care practices from 2015–2024, linked Medicare claims data, and surveys of nationally representative samples of these practices conducted in 2017 and 2022. Work in this project will entail: Aim 1: Examine U.S. trends in access to primary care for Medicare beneficiaries in traditional Fee-for-Service and Medicare Advantage and determine how these trends varied for less-advantaged populations. The team will conduct repeated cross-sectional studies of access to primary and relevant subspecialty care for Medicare enrollees and how trends in access to care varied for less-advantaged populations. Aim 2: Identify the policy-, system-, and practice-level factors associated with better processes and outcomes of care for Medicare beneficiaries, with a focus on those with fewer social and economic advantages. The team will take advantage of the substantial differences across states, delivery systems, and physician practices in the implementation of initiatives intended to improve and support primary care to apply differences-in-differences approaches to identify potentially high impact factors. Aim 3: Conduct qualitative research to deepen our understanding of the underlying barriers and facilitators to improving primary care for less advantaged populations. Under this aim, the team will conduct key informant interviews with experts on policy, primary care and the safety net to deepen our understanding of current challenges and opportunities facing safety net practices. The team will then purposively sample practices that participated in the 2022 survey that serve economically less-advantaged and minoritized populations and conduct in-depth qualitative interviews with their leaders and staff. Findings across these three aims will be triangulated to develop recommendations that can assist practice leaders, health system leaders, and policymakers in improving primary care and reducing health disparities for older adults.

抽象的美国境内的健康差异无处不在，对于某些人群而言，美国的健康差异正在扩大。高质量的初选护理在许多慢性健康的预防，诊断和管理中起着重要的作用导致老年人健康差异的条件。但是，美国的初级保健是威胁。甚至在Covid-19之前，初级保健医师的人均供应量都在下降和不同在县里龙，威胁着农村和其他不受欢迎的社区。关于如何近年来，获得高质量的初级保健的机会发生了变化，包括与之相关的访问变化与更好的政策，系统或实践级别的因素，与更好的因素有关老年人初级保健质量。这些理解差距阻碍了我们作为一个国家的能力为老年人提供最佳护理。该项目将通过吸引独特的国家来满足这一需求数据集包括有关美国所有美国初级保健实践的所有权和人员的年度信息 2015 - 2024 在2017年和2022年进行。该项目的工作将需要：AIM 1：检查美国访问美国的趋势照顾传统费用和医疗保险优势的医疗保险受益人，并确定如何这些趋势在较弱的人群中有所不同。团队将反复对获得医疗保险注册的主要和相关的亚专科护理以及如何获得护理的趋势较较低的人群各不相同。目标2：确定政策，系统和实践级别的因素与对医疗保险受益人的更好过程和护理结果有关，重点是社会和经济优势较少。团队将利用各个之间的实质性差异在实施旨在改善和支持初级保健以采用差异差异方法来识别潜在的高影响因素。目标3：进行定性研究，以加深我们对基本障碍和促进者的理解改善较少优势人群的初级保健。在此目标下，团队将主持关键的线人对政策，初级保健和安全网的专家的访谈，以加深我们对当前的理解安全网实践面临的挑战和机遇。然后，团队通常会采样的做法参加2022年的调查，该调查服务于经济上较少和少数的人口和与他们的领导者和员工进行深入的定性访谈。这三个目标的发现将是三角剖分以制定建议可以帮助实践领导者，卫生系统领导者和政策制定者改善初级保健和减少老年人的健康差异。