Exploring Pathways to Equitable Outcomes in Post-Stroke Aphasia and Dysphagia

探索中风后失语和吞咽困难的公平结果的途径

• 批准号: 10676578
• 负责人: Charles Ellis
• 金额: $ 73.14万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676578
• 关键词: Acute; Address; Aphasia; Attention; Black Populations; Black race; Caring; Characteristics; Clinical; Communication impairment; Communities; Continuity of Patient Care; Data; Deglutition Disorders; Disadvantaged; Disparity; Environment; Equity; Future; Goals; Health Personnel; Healthcare; Healthcare Systems; Impairment; Individual; Inequity; Institution; Institutional Practice; Intervention; Language; Length; Location; Measures; Medicare claim; Mission; National Institute on Deafness and Other Communication Disorders; Not Hispanic or Latino; Outcome; Pathway interactions; Patients; Play; Process; Provider; Public Policy; Quality of Care; Quality of life; Race; Recovery; Rehabilitation Outcome; Rehabilitation therapy; Research; Research Personnel; Role; Services; Speech Therapy; System; Techniques; Testing; Time; Translating; Variant; Visit; Work; acute care; acute stroke; care costs; care providers; care systems; community setting; disparity reduction; econometrics; ethnic difference; ethnic disparity; health care model; health care settings; health difference; health disparity; improved; inpatient service; minority investigator; outcome disparities; people of color; post stroke; provider behavior; provider factors; public health relevance; racial difference; racial disparity; rehabilitative care; service utilization; social; stroke outcome; stroke survivor; stroke therapy; stroke-induced aphasia; treatment services

PROJECT SUMMARY/ABSTRACT Evidence suggests quality of care has substantially improved in the in the US has over last 25 years. However, wide variability exists in the quality of care that some patient groups receive. Some suggest that structural barriers in within healthcare systems and in post-discharge community settings translate into racial-ethnic disparities in outcomes for conditions such as aphasia and dysphagia. To date, studies have not examined the role structural barriers play role in disparities in outcomes. In this study we propose to test the hypothesis that structural barriers at various stages of the post-stroke treatment condition for conditions like aphasia and dysphagia contribute to differences in quality of rehabilitation care and subsequently to racial-ethnic differences in aphasia and dysphagia outcomes. The objective of this study is to examine how healthcare institutions and healthcare provider practices impacts the receipt of quality rehabilitative care and whether it translates into racial disparities in post-stroke outcomes. The objective of this project will be achieved by the completion of the following specific aims: Aim 1: Determine how availability, accessibility, and quality of post-stroke acute inpatient care contribute to disparate outcomes of individuals with aphasia and dysphagia. We hypothesize that processes embedded in healthcare settings and communities where stroke survivors live will dictate: a) access to specific types of care, b) the path of care progression, and c) intensity of care. Aim 2: Determine how the timing and transition of care contribute to disparate outcomes of individuals with aphasia and dysphagia. We hypothesize that processes embedded in healthcare settings will lead to variations in the timing and transition from acute to post-acute care of stroke survivors with aphasia and dysphagia as they move across different facilities/systems of care. Aim 3: Determine how the post-discharge community environments contribute to disparate outcomes of individuals with aphasia and dysphagia. We hypothesize that personal, social, and community measures of prosperity and disadvantage will contribute to racial disparities in outcomes among individuals with aphasia and dysphagia. To complete this study we will use Medicare claims data which will enable us to track the care of stroke survivors with aphasia and dysphagia across the entire continuum of care.

项目摘要/摘要 证据表明，在过去的25年中，美国的护理质量在美国已经有了显着提高。然而， 某些患者群体获得的护理质量存在广泛的可变性。一些人建议结构 医疗保健系统内部和隔离后社区环境中的障碍将转化为种族族裔 失语症和吞咽困难等条件的结果差异。迄今为止，研究尚未检查 角色结构障碍在结果中的差异中起作用。在这项研究中，我们建议检验以下假设 在失语和失语症等条件下，在势后治疗条件的各个阶段的结构障碍 吞咽困难有助于康复护理质量的差异以及种族差异 在失语症和吞咽困难的结果中。这项研究的目的是研究医疗机构和 医疗保健提供者的实践会影响质量康复护理的接收，以及它是否转化为种族 势后结果的差异。该项目的目的将通过完成 以下特定目的：目标1：确定中风后急性的可用性，可及性和质量 住院护理导致失语症和吞咽困难的个体的不同结果。我们 假设嵌入了中风幸存者LIVE的医疗保健环境和社区中的过程 指示：a）获得特定类型的护理，b）护理进展的路径和c）护理强度。目标2： 确定护理的时间和过渡如何促进个人的不同结果 失语和吞咽困难。我们假设嵌入在医疗保健环境中的过程将导致变化 在从急性到急性后的中风幸存者的急剧护理和吞咽困难的时间和过渡中 跨越不同的设施/护理系统。 AIM 3：确定后收费社区如何 环境有助于失语症和吞咽困难的个体的不同结果。我们 假设个人，社会和社区的繁荣和劣势措施将有助于 失语症和吞咽困难的个体的种族差异。为了完成这项研究，我们将使用 Medicare索赔数据将使我们能够以失语和吞咽困扰跟踪中风幸存者的护理 在整个护理中。