Urban-Rural Disparities in Healthcare Quality for Children with Complex or Disabling Health Conditions

复杂或残疾儿童医疗质量的城乡差异

基本信息

批准号：
10090639
负责人：
JoAnna Leyenaar
金额：
$ 75.67万
依托单位：
DARTMOUTH-HITCHCOCK CLINIC
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-01-28 至 2023-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10090639
关键词：
Adult Ambulatory Care American Area Attenuated Caring Characteristics Child Child Care Child health care Childhood Chronic Chronic Disease Clinical Colorado Community Health Systems Complex Data Disease Management Emergency Situation Emergency department visit Ethnic Origin Ethnic group Evaluation Foundations Future Geography Health Health Personnel Health system Healthcare Healthcare Systems High Prevalence Hospital Charges Hospitalization Inpatients Insurance Intervention Knowledge Length of Stay Massachusetts Measures Medical Medicare New Hampshire Outcome Pathway Analysis Patients Pattern Patterns of Care Pediatric Hospitals Physicians Population Population Heterogeneity Poverty Preventive care Preventive healthcare Primary Health Care Provider Public Health Quality of Care Race Reporting Research Resources Retrospective cohort study Risk Rural Services Social Network Specialist Structure Surveys Time Travel Underserved Population United States Vulnerable Populations Work adverse outcome base beneficiary care outcomes care providers care systems clinical care complex chronic conditions cost disability effective intervention experience health care availability health care disparity health care quality health care service utilization health disparity high risk hospital readmission improved improved outcome medical specialties multidisciplinary novel organizational structure peer racial and ethnic readmission risk rural area rural disparities rural health disparities rural residence rural setting rurality tertiary care urban area urban setting

项目摘要

PROJECT SUMMARY/ABSTRACT A total of 11.8 million children live in rural areas of the United States, and one-quarter of these children have chronic health conditions. This population is more likely to have disabilities, less likely to receive preventative care, and more likely to report unmet healthcare needs than children who live in urban areas. As such, they represent an underserved group at high risk for disparities in health outcomes. Children with complex or disabling health conditions may be at particular risk of adverse outcomes when they live in rural areas due to their chronic and multifaceted healthcare needs. However, at a population level we know extremely little about how urban-rural disparities in health care access impact this vulnerable population. The overall objective of this proposal is to comprehensively evaluate urban-rural disparities in health care utilization and quality for children with complex or disabling health conditions using five years of all-payer claims data from three states: Colorado, Massachusetts and New Hampshire. These states represent diverse populations with respect to geography, rurality, and race/ethnicity, making them ideally suited to the proposed analyses. We will conduct a retrospective cohort study of approximately 140,000 children to: (i) identify urban-rural disparities in ambulatory, emergency and inpatient healthcare utilization, (ii) characterize urban-rural disparities in healthcare quality, (iii) identify community and health-system factors associated with urban-rural disparities in healthcare quality, and (iv) construct patient-sharing networks among physicians who care for these children to determine how patient-sharing networks differ between rural- and urban-residing children, and whether these differences are associated with disparities in quality of care. Construction of physician patient-sharing networks – that is, structural representations of relationships between physicians developed on the basis of shared patients -– provides a systematic approach to identify relationships between physicians that exist outside of formal organizational structures, which may be particularly relevant to children living in rural areas. In adult populations, network characteristics have been associated with resource utilization, practice patterns, and healthcare outcomes. However, this study will be the first to explore how physician networks differ between urban- and rural-residing children, characterizing a modifiable health system factor that may be leveraged in future work to reduce urban-rural disparities in their quality of care. This project will be conducted by a multidisciplinary team with clinical expertise providing care for children with medical complexity, as well as research expertise using all-payer claims data to evaluate healthcare quality and construct social networks. This research will generate essential data to inform the subsequent implementation and evaluation of interventions to reduce health disparities for rural-residing children with complex or disabling health conditions.

项目概要/摘要美国共有 1180 万儿童生活在农村地区，其中四分之一的儿童有该人群更有可能患有慢性健康问题，并且不太可能接受预防性治疗。与居住在城市地区的儿童相比，他们更有可能报告未得到满足的医疗保健需求。健康结果差异高风险的服务不足群体患有复杂或疾病的儿童。当他们生活在农村地区时，由于以下原因，残疾健康状况可能面临特别的不良后果风险：然而，在人口层面，我们对他们的长期和多方面的医疗保健需求知之甚少。城乡在医疗保健获取方面的差异如何影响这一弱势群体总体目标。建议全面评估儿童卫生保健利用和质量的城乡差异使用来自三个州五年的所有付款人索赔数据来处理复杂或致残的健康状况：科罗拉多州、马萨诸塞州和新罕布什尔州代表着不同的人口。地理、乡村和种族/民族，使它们非常适合拟议的分析。对大约 140,000 名儿童进行的回顾性队列研究，目的是：(i) 确定城乡差异门诊、急诊和住院医疗保健利用情况，(ii) 描述城乡差异医疗保健质量，(iii) 确定与城乡差异相关的社区和卫生系统因素医疗保健质量，以及 (iv) 在照顾这些儿童的医生之间建立患者共享网络，以确定农村和城市儿童之间的患者共享有何不同，以及这些是否差异与医患共享网络建设的差异有关。 – 也就是说，医生之间关系的结构表征是在共享的基础上发展起来的患者——提供了一种系统的方法来识别医生之间存在的外部关系正式的组织结构，这可能与生活在农村地区的儿童特别相关。人口、网络特征与资源利用、实践模式和然而，这项研究将首次探讨医生网络之间的差异。居住在城市和农村的儿童，描述了可改变的卫生系统因素，可用于未来缩小城乡护理质量差距的工作将由一个机构来开展。具有临床专业知识的多学科团队为患有医疗复杂性的儿童提供护理，以及使用所有付款人索赔数据来评估医疗保健质量并构建社交网络的研究专业知识。这项研究将生成重要数据，为后续实施和评估提供信息采取干预措施，减少患有复杂或残疾健康状况的农村儿童的健康差距。