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

• 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
• 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

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.

项目概要 医院相关残疾 (HAD)，定义为新丧失完成一项或多项日常活动的能力 近三分之一的住院 HAD 患者在出院时无法获得帮助。 住院期间行动不便与再入院、永久性残疾、新的 住院治疗、死亡和医疗费用不断上升，而获得物理治疗 (PT) 对于治疗至关重要。 功能改善，我来自单个站点的初步数据表明黑人患者在这两个方面都面临着差异 然而，目前尚不清楚跨站点是否如此。 社会脆弱性会影响这些结果，或者为什么会发生这种情况。因此，本提案旨在描述这些结果。 黑人种族和社会脆弱性与 HAD 的发展以及急性和急性后转诊之间的关系 我还致力于探索芝加哥地区学术医疗中心的物理治疗。 从流动性丧失和参与 PT 的角度来看，我挣扎于黑人种族和社会脆弱性。 我将在三个目标上检验我的假设： 目标 1) 我将评估。 HAD 和住院患者中按种族和地区剥夺指数 (ADI)（衡量社会脆弱性的指标）划分的差异 芝加哥三个学术医疗中心的物理治疗转诊在社会经济上给予了 多样化的患者样本；目标 2) 在这些医疗中心中，我还将确定种族和 ADI 的差异， 建议出院到急性后护理 (PAC) 设施进行 PT 的比率和实际出院到 PAC 的比率 目标 3) 我将使用定性方法来探索患者的体验 住院期间的行动能力丧失和参与 PT；以及跨学科护理团队的记录 我的长期目标是开发一个模型来预测 HAD 风险和获益的可能性。 住院期间熟练的身体康复，以减轻不同人群的 HAD 负担 为了实现这一目标，我组建了一支出色的跨学科导师团队（Meltzer 博士、 Arora、Lagu）和顾问（Drs. Peek、Chin、Jayaraman、Gibbons）拥有 NIH 资助和记录的记录 我对早期职业研究者进行了成功的指导，制定了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 住院患者（Arora、Lagu 和 Jayaraman），以及将种族和社会决定因素纳入 减少偏差的统计模型（Gibbons、Peek、Chin）。完成此提案将训练我解决问题。 “医疗保健系统”领域内各个层面的影响力（个人、人际、社区、社会） NIMHD 研究框架中概述的影响力 配备先进的健康技能和知识。 差异研究方法以及种族和种族主义在医疗保健中的作用，我将能够设计公正的 风险预测工具和假肢康复方案，并领导其根据文化量身定制的实施 未来 R01 级别应用中的不同人群。