DECISIONS ABOUT HMO SERVICE USE FOR LATE LIFE ILLNESS

关于针对晚年疾病使用 HMO 服务的决定

• 批准号: 2052121
• 负责人: MARGO-LEA L HURWICZ
• 金额: $ 9.47万
• 依托单位: UNIVERSITY OF MISSOURI-ST. LOUIS
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-08-15 至 1998-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2052121
• 关键词: Medicare /Medicaid; age difference; alternative medicine; decision making; gender difference; health behavior; health care model; health care service utilization; human data; human old age (65+); human subject; human very old age (85+); interview; longitudinal human study; managed care; mathematical model; population survey; racial /ethnic difference; religion; self care; socioeconomics

The proposed research seeks to understand the process by which an older adult who is experiencing an episode of illness decides whether to seek the care of a physician. Two complementary methodological approaches are taken. (l) Detailed illness episode data from a seven wave longitudinal panel study of 1009 Medicare recipients enrolled in a Health Maintenance Organization (HMO) will be used to develop a series of event history models of physician contact. The effects of various explanatory variables (sociodemographic, prior health history) and time.varying covariates (other illness response strategies) on the risk of seeking medical care will be estimated in proportional hazards models that control for specific illness types and respondent categories. (2) A sample of 150 ethnographic informants will be selected from the original group of respondents to represent theoretically relevant categories of the population (e.g., men, women, married, not married, U.S. born, immigrants, health-status). Detailed ethnographic data on illnesses experienced in later life, their causes and symptoms, and the range of available and appropriate treatment alternatives for each illness will be collected systematically using free lists, card sorts, paired comparisons, and sentence frames. These data will be analyzed using techniques such as consensus analysis, multidimensional scaling and hierarchical clustering. Expressed rules for deciding among treatment alternatives, particularly whether to contact a physician, will be explored using ethnographic decision tree modeling techniques. Both approaches should yield information useful to planners and evaluators of health education programs aimed at increasing the match between need for services as defined by the medical profession, and actual use of medical services by this population.

拟议的研究试图了解较老的过程 正在经历疾病情节的成年人决定是否寻求 医生的照顾。两种互补的方法论方法是 拍摄。 （l）七波纵向的详细疾病发作数据 参加健康维护的1009名Medicare接收者的小组研究 组织（HMO）将用于开发一系列活动历史 医师接触的模型。 各种解释变量的影响 （社会人口统计学，先前的健康历史）和时间。 （其他疾病反应策略）关于寻求医疗的风险 将以比例危害模型进行估计，以控制特定 疾病类型和受访者类别。 （2）150个民族志的样本 线人将从原始受访者组中选出 代表理论上相关的人群类别（例如，男人， 妇女已婚，未婚，美国出生，移民，健康状况）。 关于以后生命中经历的疾病的详细民族志数据 原因和症状，以及可用和适当治疗的范围 每种疾病的替代方法将系统地收集 列表，卡片，配对比较和句子框架。 这些数据 将使用共识分析等技术进行分析， 多维缩放和分层聚类。表示规则 在治疗替代方案之间做出决定，特别是是否联系 医师将使用人种学决策树建模探索 技术。两种方法都应产生对计划者有用的信息 以及旨在增加比赛的卫生教育计划的评估者 在医学界定义的服务的需求与实际 该人群使用医疗服务。