GEOGRAPHY AND DISPARITIES IN HEALTH CARE

地理和医疗保健方面的差异

基本信息

批准号：
8068755
负责人：
JONATHAN L SKINNER
金额：
$ 19.47万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
资助国家：
美国
起止时间：
至
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/8068755
关键词：
Acute myocardial infarction Affect American Angioplasty Belief Board Certification Cardiac Caring Characteristics Code Coronary Artery Bypass Data Data Linkages Discrimination Doctor of Philosophy Elderly Ethnic Origin Family Practice Geography Health Healthcare Hispanics Hospital Closures Hospitals Income Institution Internal Medicine Knee Life Link Low income Measurement Measures Medical Medicare Medicare claim Minority Modeling Monitor Myocardial Infarction Neighborhoods Operative Surgical Procedures Outcome Patient Preferences Patients Pattern Perception Performance Physicians Population Provider Quality of Care Race Recommendation Records Reporting Research Research Personnel Sampling Socioeconomic Status Solutions Sorting - Cell Movement Stress Surveys Testing Translating Treatment outcome base care seeking experience health care quality hip replacement arthroplasty patient population percutaneous coronary intervention preference programs racial and ethnic racial difference socioeconomics

项目摘要

Racial, ethnic, and socioeconomic disparities in both health care and health are well documented, but our understanding of the causes of such disparities, and potential solutions, remains incomplete. Previous research has stressed the importance of geography in understanding health care disparities, but these broad regional findings have precluded hospital-level information (or "report cards") on racial or ethnic disparities. Nor do we understand the implications for disparities if Black and white patients from the same neighborhood seek care at different types of hospitals. Our recently completed patient survey suggests large differences by race and ethnicity in beliefs about health care intensity. But we don't know how perceptions of white, Black, Hispanic, and lower income patients translate into the type of care they actually receive. Finally, it is well understood that surgical rates are lower among Black AMI patients, but it is not well understood what the implications are of these lower surgical rates for disparities in health outcomes; and more importantly, what would be the benefits of raising Black surgical rates following AMI. The specific aims are: 1. Develop hospital-level disparity "report cards" for hospital performance with regard to racial, ethnic, or income-based differences in treatment patterns such as quality of care measures and knee and hip replacements using patient-doctor-hospital networks estimated in Core B and Project 1, and quantify the differences in the quality of health care institutions and providers utilized by Black and white patients. 2. Characterize the sorting of patients and providers by race, ethnicity, and socioeconomic status. What is the impact on health outcomes when minority or low-income patients seek care (or are only able to receive care) at largely Black/Hispanic or low-income hospitals, whether through choice or because of hospital closures? 3. Test whether the preferences of patients, as elicited by a recent nation-wide survey of Medicare enrollees, are reflected in the type of health care they subsequently receive, and whether this concordance varies systematically by race, ethnicity, or socioeconomic status using linked Medicare claims data. 4. Estimate the impact of differential racial, ethnic, and income-based cardiac surgical rates on disparities in health outcomes using a large sample (3 million observation) of elderly heart attack patients. Do Black surgical candidates experience better, at the margin, than white surgical candidates?

医疗保健和健康方面的种族、民族和社会经济差异都有据可查，但我们对造成这种差异的原因和潜在解决方案的理解仍然不完整。以前的研究强调了地理在理解医疗保健差异方面的重要性，但这些广泛的区域调查结果排除了医院层面有关种族或族裔差异的信息（或“成绩单”）。我们也不明白如果来自同一社区的黑人和白人患者对差异的影响到不同类型的医院寻求治疗。我们最近完成的患者调查表明，不同种族和民族的信念存在巨大差异医疗保健强度。但我们不知道白人、黑人、西班牙裔和低收入群体的看法如何患者转化为他们实际接受的护理类型。最后，众所周知，手术率黑人 AMI 患者中的死亡率较低，但尚不清楚这些较低的影响是什么健康结果差异的手术率；更重要的是，提高的好处是什么？ AMI 后黑人的手术率。具体目标是： 1. 制定医院级别差异“报告卡”，记录医院在种族、民族或种族方面的表现基于收入的治疗模式差异，例如护理质量措施以及膝关节和髋关节使用核心 B 和项目 1 中估计的患者-医生-医院网络进行替代，并量化黑人和白人患者使用的医疗保健机构和提供者的质量存在差异。 2. 按种族、民族和社会经济地位描述患者和提供者的分类特征。什么是当少数族裔或低收入患者寻求护理（或只能接受治疗）时对健康结果的影响护理）在主要是黑人/西班牙裔或低收入医院，无论是通过选择还是因为医院关闭？ 3. 测试患者的偏好是否符合最近的一项全国范围的医疗保险调查登记者的情况，反映在他们随后接受的医疗保健类型中，以及这种一致性是否符合使用链接的医疗保险索赔数据，根据种族、民族或社会经济地位系统地变化。 4. 估计不同种族、民族和收入的心脏手术率对差异的影响使用老年心脏病患者的大样本（300 万观察）来评估健康结果。做黑色外科候选人比白人外科候选人体验更好吗？