Improving Access to Care and Chronic Condition Management for Rural Older Adults in the US

项目摘要/摘要 候选人：Paula Chatterjee，医学硕士，医学硕士，早期健康服务研究员和普通内科医生 有兴趣改善农村老年人获得护理的机会，缩小城乡健康差距。她 旨在发展老化方面的内容专业知识；扩展她的混合方法研究技能；并过渡到 致力于改善老年人健康和缩小健康差距的独立调查者。 研究背景：老年人在美国农村社区中所占的比例越来越大， 但与城市同龄人相比，他们患有更多的慢性病，获得护理的机会有限。农村 医院越来越多地为老年人提供基本的住院和门诊护理，在财务上举步维艰 并面临着加速关闭的风险。已将乡村医院的全球预算作为一项战略提出，以 为乡村医院提供财政支持，以避免关闭的风险，同时将农村护理提供转变为最优 管理慢性病，缩小城乡健康差距。了解全球预算可能 实现这些成果对于理解如何加强农村卫生保健系统至关重要。 具体目标：(1)描述获得护理、慢性病管理和相应的农村-- 美国老年人之间的城市差距；(2)估计获得护理的机会、慢性病的变化 在采用全球农村发展预算后，老年人的管理和城乡差距 医院；及(3)质的 慢性 确定以医院为基础的促进者和障碍，以保持访问、改进 条件管理，缩小农村老年人的差距。 研究计划：利用健康和退休研究和联邦医疗保险索赔，查特吉博士将首先描述 在获得护理和慢性病管理方面的趋势，然后使用综合控制方法 评估在宾夕法尼亚州农村医院引入全球预算与以下各项之间的关联 结果。然后，查特吉博士将从宾夕法尼亚州农村医院的管理人员那里收集原始数据，以便更好地 了解他们为保持可及性、改善慢性病管理和缩小差距所做的努力。 职业发展计划：Chatterjee博士将(1)发展老龄化和医疗保健提供方面的内容专业知识 针对老年人，特别是农村社区的老年人；(2)拓宽和巩固因果关系的研究技能 推理、定性方法和实施科学；以及(3)执行一项研究议程，重点是 改善患有慢性病的老年人的健康状况。她将在一支由 老龄化、农村健康、健康差距、计量经济学和定性方法方面的领先专家。 环境：宾夕法尼亚大学是实现这些培训目标的理想环境 由经验丰富的多学科导师和顾问团队提供指导，这些顾问和顾问在 在老龄化和健康服务研究方面培养独立的健康服务研究人员。

PROJECT SUMMARY/ABSTRACT Candidate: Paula Chatterjee, MD MPH is an early stage health services researcher and general internist interested in improving access to care for rural older adults and narrowing rural-urban health disparities. She aims to develop content expertise in aging; expand her mixed method research skills; and transition into an independent investigator dedicated to improving the health of older adults and narrowing health disparities. Research Context: Older adults make up a growing portion of rural communities in the United States (US), but have more chronic conditions and limited access to care compared to their urban counterparts. Rural hospitals, which increasingly provide essential inpatient and outpatient care for older adults, struggle financially and are at accelerating risk of closure. Global budgets for rural hospitals have been proposed as a strategy to financially bolster rural hospitals to stave off risks of closure, while transforming rural care delivery to optimally manage chronic conditions and narrow rural-urban health disparities. Understanding how global budgets might achieve these outcomes is critically important to understanding how to strengthen rural health care systems. Specific Aims: (1) Describe trends in access to care, chronic condition management, and corresponding rural- urban disparities among older adults in the US; (2) estimate changes in access to care, chronic condition management, and rural-urban disparities among older adults after the introduction of global budgets for rural hospitals; and (3) qualitatively chronic identify hospital-based facilitators and barriers to preserving access, improving condition management, and narrowing disparities for rural older adults. Research Plan: Using the Health and Retirement Study and Medicare claims, Dr. Chatterjee will first describe trends in access to care and chronic condition management, and then use a synthetic control approach to evaluate the association between the introduction of global budgets in rural Pennsylvania hospitals and these outcomes. Dr. Chatterjee will then collect primary data from rural Pennsylvania hospital executives to better understand their efforts to preserve access, improve chronic condition management, and narrow disparities. Career Development Plan: Dr. Chatterjee will (1) develop content expertise in aging and health care delivery for older adults, particularly those in rural communities; (2) broaden and solidify research skills in causal inference, qualitative methods and implementation science; and (3) execute a research agenda focused on improving the health of older adults with chronic conditions. She will achieve these goals under a team of leading experts in aging, rural health, health disparities, econometrics, and qualitative methods. Environment: The University of Pennsylvania is an ideal environment to achieve these training aims under the guidance of an experienced and multidisciplinary team of Mentors and Advisors with a strong track record in developing independent health services researchers in aging and health services research.