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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要有证据表明，过去 25 年来，美国的护理质量有了显着提高。然而，一些患者群体接受的护理质量存在很大差异。有人建议结构性医疗保健系统内和出院后社区环境中的障碍转化为种族民族失语症和吞咽困难等疾病的结果存在差异。迄今为止，研究尚未检验结构性障碍在结果差异中发挥着重要作用。在这项研究中，我们建议检验以下假设：中风后治疗不同阶段的结构性障碍，例如失语症和吞咽困难会导致康复护理质量的差异，进而导致种族差异失语和吞咽困难的结果。本研究的目的是研究医疗机构和医疗保健提供者的做法会影响高质量康复护理的获得以及它是否会转化为种族歧视中风后结果的差异。该项目的目标将通过完成以下具体目标：目标 1：确定中风后急性治疗的可用性、可及性和质量如何住院护理会导致失语症和吞咽困难患者出现不同的结果。我们假设中风幸存者居住的医疗保健环境和社区中嵌入的流程将规定：a) 获得特定类型的护理，b) 护理进展路径，以及 c) 护理强度。目标 2：确定护理的时间安排和过渡如何影响患有此病的个体的不同结果失语和吞咽困难。我们假设医疗保健环境中嵌入的流程将导致变化患有失语和吞咽困难的中风幸存者从急性护理到急性后护理的时机和过渡跨不同的护理设施/系统。目标 3：确定出院后社区如何环境会导致失语症和吞咽困难患者出现不同的结果。我们假设个人、社会和社区的繁荣和劣势衡量标准将有助于失语症和吞咽困难患者的结果存在种族差异。为了完成这项研究，我们将使用医疗保险索赔数据将使我们能够跟踪患有失语和吞咽困难的中风幸存者的护理情况贯穿整个护理连续过程。