Treatment of Displaced, Low Income Children with Chronic Conditions

流离失所、低收入慢性病儿童的治疗

基本信息

批准号：
8680635
负责人：
Troy Quast
金额：
$ 7.76万
依托单位：
SAM HOUSTON STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-06-01 至 2015-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8680635
关键词：
Accident and Emergency department Affect African American Am 80 Asthma Attention deficit hyperactivity disorder Caring Child Child Care Child health care Chronic Control Groups Data Destinations Diabetes Mellitus Diabetic Ketoacidosis Diagnosis Disadvantaged Disasters Drug Utilization Emergency Situation Enrollment Event Feedback Future Goals Grant Health Health Insurance Health Personnel Healthcare Hospitalization Household Hurricane Income Individual Inpatients Institutes Intervention Investigation Louisiana Low income Medicaid Medical Mental Health Minority Natural Disasters Obesity Outpatients Paper Patient Self-Report Pharmaceutical Preparations Policies Population Prevalence Psychologist Publishing Qualifying Relative (related person)Reporting Research Retinal Rice Risk Sampling School-Age Population Services Simulate Social Workers Surveys Symptoms Testing Texas To specify Universities Visit Vulnerable Populations Weather adverse outcome behavioral health demographics diabetic emotional trauma gulf coast health care service utilization health economics high risk improved insight low socioeconomic status model design programs public health relevance socioeconomics waiver

项目摘要

DESCRIPTION (provided by applicant): Over 1.5 million people evacuated the U.S. Gulf Coast following Hurricane Katrina (Groen and Polivka, 2007) and over 250,000 were estimated to have continued to reside in Texas nearly one year later (Texas HHS, 2006). Not only were these evacuees exposed to physical and emotional trauma, but many were from vulnerable populations and of low socio-economic status that further worsened their condition. Roughly 80% of all individuals displaced to Texas following Katrina were African American, while 60% came from households whose income was less than $20,000 per year (Texas HHSC, 2006). Children were especially vulnerable, with many missing health provider visits (Rath et al., 2007) and reporting a new onset of mental health symptoms following Katrina (Roberts, 2010). This goal of this proposal is to analyze the diagnoses and treatment of selected chronic conditions for Displaced Louisiana Children (DLCs) from low socio-economic backgrounds following Hurricane Katrina. The analysis will employ individual-level administrative data to examine the health care utilization of the roughly 30,000 DLCs enrolled in TexKat, the temporary emergency Medicaid waiver program for Katrina evacuees in Texas. The use of these data represents a potential improvement over the vast majority of existing post-disaster studies which typically employ survey data. The investigation will focus on healthcare for three chronic conditions: asthma, mental health, and diabetes. The analysis will focus on encounter rates in outpatient, emergency department, and inpatient settings as well as prescription rates for treatment medications. A difference-in-differences estimation strategy will be employed to identify changes due to displacement. Changes in utilization by DLCs before and after displacement will be compared to changes in utilization by non-displaced children. The analysis is expected to indicate that displacement was very disruptive to DLCs with chronic conditions (Rath et al., 2007). The project will provide critical information to federal, state and local agencies planning care for low-income children following disasters. The analyses of diagnoses and health care use both immediately following displacement and in the following months will provide insight into the health care needs for conditions known to be exacerbated by discontinuous medical care. By determining the services obtained by these children, our findings will assist evacuation destinations to more efficiently prepare for an influx of evacuees. Finally, policymakers may be able to use our findings to improve future Medicaid emergency waivers.

描述（由申请人提供）：卡特里娜飓风过后，美国墨西哥湾沿岸有超过 150 万人撤离（Groen 和 Polivka，2007 年），预计近一年后仍有超过 25 万人继续居住在德克萨斯州（德克萨斯州 HHS，2006 年）。这些撤离者不仅遭受身体和情感创伤，而且许多人来自弱势群体，社会经济地位较低，这进一步恶化了他们的状况。卡特里娜飓风后流离失所到德克萨斯州的所有个人中，大约 80% 是非裔美国人，而 60% 来自年收入低于 20,000 美元的家庭（德克萨斯州 HHSC，2006 年）。儿童尤其容易受到伤害，许多人错过了医疗服务提供者的就诊（Rath 等人，2007 年），并且报告说，卡特里娜飓风后出现了新的心理健康症状（Roberts，2010 年）。本提案的目标是分析卡特里娜飓风后社会经济背景较低的路易斯安那州流离失所儿童 (DLC) 特定慢性病的诊断和治疗情况。该分析将利用个人层面的管理数据来检查参加 TexKat 的大约 30,000 名 DLC 的医疗保健利用率，TexKat 是针对德克萨斯州卡特里娜飓风撤离人员的临时紧急医疗补助豁免计划。这些数据的使用代表着对现有绝大多数通常采用调查数据的灾后研究的潜在改进。该调查将重点关注三种慢性疾病的医疗保健：哮喘、心理健康和糖尿病。该分析将重点关注门诊、急诊室和住院患者的就诊率以及治疗药物的处方率。将采用双重差分估计策略来识别位移引起的变化。 DLC 在流离失所前后的利用变化将与非流离失所儿童的利用变化进行比较。分析预计表明，移位对患有慢性疾病的 DLC 具有很大的破坏性（Rath 等，2007）。该项目将为联邦、州和地方机构提供重要信息，以规划灾害后低收入儿童的护理。对流离失所后立即和接下来几个月的诊断和医疗保健使用情况进行分析，将深入了解已知因不连续医疗护理而加剧的情况的医疗保健需求。通过确定这些儿童获得的服务，我们的调查结果将帮助疏散目的地更有效地为大量疏散人员的涌入做好准备。最后，政策制定者也许能够利用我们的研究结果来改善未来的医疗补助紧急豁免。