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

项目摘要 一个多世纪以来，阿巴拉契亚农村一直在为健康和医疗保健服务而苦苦挣扎。对于儿童来说，缺乏 获得医疗保健服务的机会从出生时开始，产前护理资源有限，一直持续到生命的结束 儿科收容所的准入受到限制。这项研究的主要目的是调查 扩大获得儿科临终关怀(同步护理)的机会，以减少城乡儿童和 青少年健康结果(症状管理、护理连续性和成本)。要做到这一点，我们将获得， 链接和分析来自各种来源的数据，包括2011-2014年的医疗补助数据、美国人口普查和临终关怀 提供程序文件。我们将利用地理信息系统和比较有效性数据分析 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。独一无二的 我们建议的研究的一个方面是使用绘图技术来直观地显示城乡在获取 阿巴拉契亚地区的儿科临终关怀。通过检查这些数据，我们将能够评估并发 关注城乡差距和严重缺乏服务的人口的健康结果。为…的健康 儿童和青少年在阿巴拉契亚地区继续下降，这一信息具有重大意义 对临床医生、政策制定者和家庭的重要性。这条调查路线预计最终会有所改善 在阿巴拉契亚为儿童、青少年及其家人提供优质的临终关怀。

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.