Improving Native American Elder Access to and Use of Healthcare through Effective Health System Navigation

通过有效的卫生系统导航，改善美国原住民老年人获得和使用医疗保健的机会

基本信息

批准号：
9103209
负责人：
Cathleen E. Willging
金额：
$ 50.2万
依托单位：
PACIFIC INSTITUTE FOR RES AND EVALUATION
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-01 至 2019-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9103209
关键词：
Address Administrator Adult Affect Affordable Care Act Age Aging American American Indians Belief Caring Chronic Collaborations Communication Communities Cost Sharing Coupled Data Deductibles Development Elderly Eligibility Determination Enrollment Environment Evaluation Evaluation Research Focus Groups Funding General Population Government Health Health Care Reform Health Insurance Health Services Accessibility Health system Healthcare Healthcare Systems Home environment Improve Access Indian reservation Inequality Insurance Insurance Coverage Intervention Interview Knowledge Laws Life Expectancy Light Managed Care Programs Mediation Medicaid Medical Medicare Medicare/Medicaid Mental disorders Methods Modeling Morbidity - disease rate Native Americans New Mexico Outcome Parents Patients Persons Physically Handicapped Policies Population Poverty Procedures Process Provider Public Sector Quality of life Research Research Design Research Institute Research Proposals Reservations Resources Running Services Structure System Techniques Tribes Underserved Population Uninsured United States Indian Health Service Universities Vulnerable Populations Work care seeking care systems concept mapping ethnic minority population experience health care availability health care disparity health disparity health literacy help-seeking behavior improved information gathering innovation literacy neglect novel outreach prevent programs racial minority social stigma tribal leader

项目摘要

DESCRIPTION (provided by applicant): Major public insurance reforms of the past two decades, i.e., those requiring enrollment into managed care programs, have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older, who suffer from poorer quality of life and lower life expectancies compared to all other aging populations in the U.S. American Indian elders represent a neglected group within the nation's healthcare system. Despite the pervasive belief that the Indian Health Service (IHS) will fully address their health-related needs, elders are negatively affected by gaps in insurance and lack of access to healthcare. Since 2014, the Patient Protection and Affordable Care Act, plus state Medicaid expansion, has made it possible for American Indian elders who are not yet eligible for Medicare to benefit from healthcare coverage. The Affordable Care Act is also intended to improve access to and quality of services for seniors in Medicare and includes special provisions to ameliorate healthcare disparities for American Indians. This proposed five-year, community-driven study features a mixed-method, participatory research design to examine insurance-related outreach activities under the Affordable Care Act, help-seeking behavior, and the healthcare experiences of American Indian elders in New Mexico, home to 22 federally-recognized Pueblos and Tribes. This study combines qualitative and quantitative interviews with concept-mapping techniques and focus groups. The information gathered will generate new practical knowledge, grounded in the actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will also inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of healthcare by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on the AIE population, and will offer a replicable model for enhancing the effects of the Affordable Care Act on other underserved groups affected by inequities in healthcare.

描述（由申请人提供）：过去二十年的主要公共保险改革，即要求参加管理式医疗计划的改革，未能实质性地解决美国印第安人的总体医疗保健需求，更不用说美国印第安老年人的特殊需求了与美国所有其他老龄化人口相比，55 岁及以上的美国印第安人老年人的生活质量较差，预期寿命较低，但他们在国家医疗保健系统中却是一个被忽视的群体。人们普遍认为印度医疗服务 (IHS) 将充分满足他们的健康相关需求，但自 2014 年以来，《患者保护和平价医疗法案》以及国家扩大的医疗补助计划，老年人受到保险缺口和缺乏医疗保健的负面影响。使尚未符合医疗保险资格的美国印第安人老年人能够从医疗保险中受益。《平价医疗法案》还旨在改善老年人获得医疗保险的服务和质量，并包括改善医疗保健差距的特殊条款。美国印第安人。这项拟议的为期五年、社区驱动的研究采用混合方法、参与性研究设计，旨在检查《平价医疗法案》下与保险相关的外展活动、寻求帮助的行为以及新州美国印第安老年人的医疗保健经历。墨西哥，拥有 22 个联邦认可的普韦布洛人和部落。这项研究将定性和定量访谈与概念图技术和焦点小组结合起来。收集的信息将产生新的实用知识，以美洲印第安人长者的实际观点为基础。和其他相关利益相关者，以改善在很大程度上被排除在国家和各州医疗改革讨论之外的人群的医疗保健实践和政策。研究数据还将为制定和评估文化定制规划提供信息，以增强对不断变化的格局的理解并促进谈判。这项工作将填补公共保险计划研究的空白，这些计划通常不关注 AIE 人群，并将提供一个可复制的模型，以增强《平价医疗法案》对其他受影响群体的影响。医疗保健方面的不平等。