Improving the Health of Low-SES Americans Approaching Retirement Under the Affordable Care Act

项目总结/摘要 候选人：Renuka Tipirneni，医学博士，理学硕士是一名普通内科医生和初级卫生服务研究员，专注于 改善医疗保健系统的过早老化低社会经济地位（SES）的成年人接近 退休年龄Tipirneni博士的长期职业目标是成为一名独立的混合方法 研究者将大规模的临床和经济数据与深入的定性数据相结合， 设计和评估政策和方案，以改善低社会经济地位老年人的健康。 研究背景：接近退休的低社会经济地位美国人面临着健康状况不佳的危机， 增加死亡率。2001年至2014年间，低社会经济地位和高社会经济地位成年人之间的预期寿命差距 临近退休的人数增加，这可能是50万多人死亡的原因。然而， 危机知之甚少。《平价医疗法案》（ACA）应通过保险改善医疗服务 扩大和护理提供创新，并帮助这一群体管理慢性病， 健康然而，目前尚不清楚低社会经济地位的老年人如何具体受益于ACA政策， 群体应该主要针对ACA鼓励的新的护理提供计划，以及 这些因素与成功改善健康状况和降低处于风险中的美国老年人的成本有关。 具体目标：1）确定低社会经济地位人口在覆盖面、获得、利用、健康和财政压力方面的变化 ACA医疗补助扩展前后的55-64岁人群; 2）对低SES 55-64岁人群进行分类， 健康状况不佳风险最高的奥尔兹，在获得、利用、健康和 确定高风险亚组的成本; 3）确定改善健康的促进因素和障碍 结果和卫生保健利用之间的高风险低社会经济地位的老年人在ACA护理提供计划。 研究计划：为了实现这些目标，Tipirneni博士将使用 健康和退休研究，以评估ACA前后的健康和医疗保健变化。她将 然后确定低社会经济地位的亚组接近退休的成年人在高风险的健康状况不佳的轨迹。最后她 将在ACA护理交付计划中与低SES接近退休的成年人进行资格面试， 确定促进和阻碍健康改善和降低高成本利用的因素。 职业发展计划：Tipirneni博士将在1）大规模纵向调查分析方面发展专业知识 和行政数据; 2）应用准实验方法评估方案; 3）混合 方法研究;和4）以老年人为重点的方案研究。Tipirneni博士的职业发展 目标将得到来自跨学科团队的密切指导的支持;高级教学课程; 参加研究和职业发展会议/研讨会;并在她的研究中不断提供指导。 环境：密歇根大学为她提供了理想的环境来追求这一培训， 杰出的导师和跨学科机构的指导，致力于她的成功。

PROJECT SUMMARY / ABSTRACT Candidate: Renuka Tipirneni, MD, MSc is a general internist and junior health services researcher focused on improving the health care system for prematurely aging low socioeconomic status (SES) adults approaching retirement age. Dr. Tipirneni's long-term career objective is to become an independent mixed methods investigator integrating large-scale clinical and economic data with in-depth qualitative data to inform the design and evaluation of policies and programs to improve the health of low-SES aging adults. Research Context: Low-SES Americans approaching retirement face a crisis of poor health and markedly increasing mortality. Between 2001 and 2014, disparities in life expectancy between low- and high-SES adults near retirement have widened and this may have accounted for 500,000 excess deaths. Yet the drivers of this crisis are poorly understood. The Affordable Care Act (ACA) should improve access to care through insurance expansions and care delivery innovations and help this group manage chronic conditions and improve their health. However, it is not clear how low-SES aging adults are specifically benefitting from ACA policies, which groups should be principally targeted for new care delivery programs encouraged under the ACA, and what factors are associated with successful health improvement and decreased costs for at-risk aging Americans. Specific Aims: 1) Determine changes in coverage, access, utilization, health and financial stress for low-SES 55-64-year-olds before and after the ACA Medicaid expansion; 2) Classify sub-groups of low-SES 55-64-year- olds at highest risk of poor health and characterize heterogeneity of changes in access, utilization, health and costs in identified high-risk sub-groups; 3) Identify facilitators of and barriers to improvements in health outcomes and health care utilization among high-risk low-SES aging adults in an ACA care delivery program. Research Plan: To accomplish these aims, Dr. Tipirneni will perform quasi-experimental analyses with the Health and Retirement Study to assess health and health care changes before and after the ACA. She will then identify sub-groups of low-SES near retirement adults at high risk of poor health trajectories. Lastly, she will conduct qualitiatve interviews with low-SES near retirement adults in an ACA care delivery program to identify facilitators of and barriers to health improvement and decreased high-cost utilization. Career Development Plan: Dr. Tipirneni will develop expertise in 1) analysis of large-scale longitudinal survey and administrative data; 2) application of quasi-experimental approaches to evaluate programs; 3) mixed methods research; and 4) programmatic research focused on aging adults. Dr. Tipirneni's career development goals will be supported by close mentorship from an interdisciplinary team; advanced didactic coursework; participation in research and career development meetings/seminars; and ongoing guidance in her research. Environment: The University of Michigan offers the ideal environment for her to pursue this training, with the outstanding guidance of well-established mentors and interdisciplinary institutes dedicated to her success.