Racial Differences in Hospital-Associated Disability and Acute and Post-Acute Care Physical Therapy Utilization

医院相关残疾以及急性和急性后护理物理治疗利用的种族差异

基本信息

批准号：
10785500
负责人：
Maylyn Martinez
金额：
$ 13.45万
依托单位：
UNIVERSITY OF CHICAGO
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：
2023-09-24 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10785500
关键词：
Academic Medical Centers Activities of Daily Living Acute Address Admission activity Affect Age Area Black race Caring Cessation of life Chicago Clinical Data Communities Complex Data Decision Making Dementia Development Development Plans Disadvantaged Disparity Documentation Face Funding Future Goals Health Care Costs Health Disparities Research Health care facility Healthcare Healthcare Systems Hospitalization Hospitals Hylobates Genus Impairment Individual Inpatients Institutionalization Intervention K-Series Research Career Programs Knowledge Lead Length of Stay Logistic Regressions Measures Medical Medical Care Team Medical center Mentors Mentorship Modeling National Institute on Minority Health and Health Disparities Outcome Patient Discharge Patients Peripheral arterial disease Physical Function Physical Rehabilitation Physical therapy Population Heterogeneity Prevention Protocols documentation Qualitative Methods Race Recommendation Rehabilitation therapy Research Research Methodology Research Personnel Resources Risk Role Sampling Site Statistical Models Testing Training Trauma Underserved Population United States National Institutes of Health Variant Woman Work acute care age stratification black patient black women care systems career career development clinical data warehouse comorbidity deconditioning deprivation design disability disability risk experience functional decline functional disability functional improvement functional outcomes health care disparity health disparity high risk hospital readmission human old age (65+)implementation science improved indexing member patient population phenomenological models predictive tools prevent racial determinant racial difference racial disparity racism readmission risk risk prediction sex skills social determinants social vulnerability socioeconomics

项目摘要

PROJECT SUMMARY Hospital-associated disability (HAD), defined as the new loss of ability to complete one or more activities of daily living without assistance at hospital discharge, occurs in nearly one-third of all hospitalized patients. HAD and low mobility during hospitalization are associated with readmissions, permanent disability, new institutionalization, death and escalating healthcare costs. While access to physical therapy (PT) is critical for functional improvement, my preliminary data from a single site suggests Black patients face disparities in both functional impairments and PT referrals. However, it is currently unclear whether this is true across sites, whether social vulnerability affects these outcomes, or why this occurs. Therefore, this proposal aims to characterize the association of Black race and social vulnerability with development of HAD and referral for acute and post-acute physical therapy across a set of Chicago area academic medical centers. I also aim to explore racial differences in perspectives on mobility loss and participation in PT. I hypothesize that Black race and social vulnerability are associated with HAD and physical rehabilitation use. I will test my hypothesis in three aims: Aim 1) I will assess differences, by race and Area Deprivation Index (ADI), a measure of social vulnerability, in HAD and inpatient physical therapy referrals in three academic medical centers across Chicago conferring a socioeconomically diverse patient sample; Aim 2) Across these medical centers, I will also determine differences by race and ADI, in rates of recommendation for discharge to post-acute care (PAC) facilties for PT and actual discharge to PAC facilities for PT when recommended; Aim 3) I will use qualitative methods to explore patients’ experiences with mobility loss and participation in PT during hospitalization; and interdisciplinary care team documentation for Black vs. White patients. My long-term goal is to develop a model to predict HAD risk and likelihood of benefit from skilled physical rehabilitation during hospitalization to reduce the burden of HAD on diverse populations of patients. To accomplish this, I have developed an exceptional interdisciplinary team of mentors (Drs. Meltzer, Arora, Lagu) and advisors (Drs. Peek, Chin, Jayaraman, Gibbons) who have a track record of NIH-funding and successful mentorship of early career investigators. I have formulated an in-depth career development plan to gain expertise in health disparities research (Chin, Peek, Meltzer), disability and physical rehabilitation in hospitalized patients, (Arora, Lagu, and Jayaraman), and incorporation of race and social determinants in statistical modeling to reduce bias (Gibbons, Peek, Chin). Completion of this proposal will train me to address each level of influence (individual, interpersonal, community, societal) within the “healthcare system” domain of influence outlined in the NIMHD’s research framework. Equipped with advanced skills and knowledge in health disparities research methodology and the role of race and racism in healthcare, I will be able to design unbiased risk prediction tools and physical rehabilitation protocols and lead their culturally-tailored implementation in diverse populations in future R01 level applications.

项目摘要与医院相关的残疾（HAS）定义为完成每日一次或多个活动的新能力丧失在出院时没有援助的生活，在所有住院患者中，近三分之一发生。有住院期间的流动性低与再入院，永久残疾，新的有关制度化，死亡和医疗保健费用不断升级。虽然获得物理治疗（PT）对于功能性改进，我来自一个站点的初步数据表明，黑人患者面临着两者的分布功能障碍和PT转介。但是，目前尚不清楚这是否在各个站点之间是正确的，是否社会脆弱性会影响这些结果，或者为什么发生这种情况。因此，该建议旨在表征黑人种族和社会脆弱性与急性和急性后的发展和推荐一组芝加哥地区学术医疗中心的物理治疗。我也旨在探索种族差异关于流动性丧失和参与PT的观点。我假设黑人种族和社会脆弱性是与HAT和身体康复的使用相关。我将以三个目的测试我的假设：目标1）我将评估差异，划分种族和地区剥夺指数（ADI），衡量社会脆弱性的度量，住院和住院芝加哥会议的三个学术医疗中心的物理治疗转介在社会经济上多样化的患者样本；目标2）在这些医疗中心，我还将确定种族和ADI的差异，在排放急性后护理（PAC）设施的推荐率和PAC的实际排放率建议时PT的设施；目标3）我将使用定性方法来探索患者的经验住院期间的流动性丧失和参与PT；和跨学科护理团队文件黑人与白人患者。我的长期目标是开发一个模型来预测有风险和利益的可能性从住院期间熟练的身体康复到减少对潜水员种群的燃烧患者。为了实现这一目标，我建立了一个杰出的跨学科导师团队（Meltzer博士， Arora，Lagu）和顾问（Peek博士，Chin，Jayaraman，Gibbons），他们拥有NIH资金的记录和早期职业调查员的成功心态。我已经制定了一个深入的职业发展计划获得健康差异研究（CHIN，PEEK，MELTZER），残疾和身体康复方面的专业知识住院的患者（Arora，Lagu和Jayaraman），并在统计建模以减少偏差（Gibbons，Peek，Chin）。该提案的完成将训练我解决在“医疗保健系统”领域内的每个影响力（个人，人际，社区，社会） NIMHD的研究框架中概述了影响力。配备了高级技能和健康知识差异研究方法论以及种族和种族主义在医疗保健中的作用，我将能够设计公正风险预测工具和身体康复方案，并领导其文化范围的实施未来R01级应用中的不同人群。