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

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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.