Effectiveness of end-of-life strategies to improve pediatric health outcomes and reduce disparities in rural Appalachia

项目摘要 阿巴拉契亚的农村地区在医疗卫生方面已经挣扎了世纪。对于儿童，缺乏 在产前护理资源有限的情况下， 限制进入儿童临终关怀中心本研究的主要目的是探讨 扩大获得儿科临终关怀的机会，以减少城乡儿童和青少年的不平等， 青少年健康结果（症状管理，护理连续性和成本）。为了做到这一点，我们将获得， 链接和分析来自各种来源的数据，包括2011-2014年医疗补助数据、美国人口普查和临终关怀 提供程序文件。我们将采用地理信息系统和比较有效的数据分析 方法，其中我们将控制患者/家庭，临终关怀提供者和社区特征。一个独特 我们提出的研究的一个方面是使用绘图技术来可视化农村/城市在获得 阿巴拉契亚的儿科临终关怀通过检查这些数据，我们将能够评估并发 保健对城乡差距和服务严重不足人口的健康结果的影响。作为健康的 儿童和青少年在阿巴拉契亚地区继续下降，这一信息是主要的 对临床医生、政策制定者和家庭的重要性。这条调查路线有望最终得到改善 为阿巴拉契亚的儿童、青少年及其家庭提供高质量的护理。

Project Summary Rural Appalachia has struggled with health and healthcare access for more than a century. For children, lack of access to healthcare services starts at birth with limited prenatal care resources and continues to end of life with restricted access to pediatric hospice. The main objective of this study is to investigate the effect of expanding access to pediatric hospice care (concurrent care) to reduce rural/urban disparities in child and adolescent health outcomes (symptom management, care continuity, and costs). To do this, we will obtain, link, and analyze data from a variety of sources including 2011-2014 Medicaid data, U.S. Census, and hospice provider files. We will employ geographic information systems and comparative effectiveness data analytic methods, in which we will control for patient/family, hospice provider, and community characteristics. A unique aspect of our proposed study is the use of mapping techniques to visualize rural/urban disparities in access to pediatric hospice care in Appalachia. By examining these data, we will be able to assess impact of concurrent care on rural/urban disparities and health outcomes in a significantly underserved populations. As the health of children and adolescents continues to decline in the Appalachian region, this information is of major importance to clinicians, policy-makers, and families. This line of investigation is expected to ultimately improve the quality care for children, adolescents, and their families at end of life in Appalachia.