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

改善美国农村老年人获得护理和慢性病管理的机会

• 批准号: 10483177
• 负责人: Paula Chatterjee
• 金额: $ 16.69万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-15 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10483177
• 关键词: Address; Adopted; Adult; Affect; Affordable Care Act; Aging; Ambulatory Care; Budgets; Caring; Chronic; Communities; Continuity of Patient Care; Country; Data; Death Rate; Development Plans; Diagnosis; Elderly; Environment; Evaluation; Future; Goals; Growth; Health; Health Services; Health Services Accessibility; Health Services Research; Health and Retirement Study; Healthcare Systems; Heart Diseases; Hospitalization; Hospitals; Human Resources; Improve Access; Infrastructure; Internist; Interview; Learning Skill; Life Expectancy; Malignant Neoplasms; Measures; Medicare claim; Mentors; Mentorship; Methods; Modeling; Morbidity - disease rate; Outcome; Patient-Focused Outcomes; Patients; Pattern; Pennsylvania; Physicians; Population; Qualitative Methods; Qualitative Research; Quasi-experiment; Research; Research Methodology; Research Personnel; Risk; Rural; Rural Community; Rural Health; Rural Hospitals; Rural Population; Site; Source; Stroke; Surveys; System; Time; Training; United States; Universities; Visit; aged; base; care delivery; career development; design; econometrics; experience; health care availability; health care delivery; health disparity; health related quality of life; implementation science; improved; improved outcome; innovation; inpatient service; insight; interest; medical specialties; mortality; multidisciplinary; novel; novel strategies; payment; preservation; programs; prospective; readmission rates; response; rural area; rural disparities; rural healthcare; skills; treatment as usual; trend; urban disparity; urban health disparities

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.

项目总结/摘要 候选人：Paula Chatterjee，医学博士MPH是一名早期健康服务研究员和普通内科医生 他们对改善农村老年人获得保健的机会和缩小城乡保健差距感兴趣。她 旨在发展老龄化的内容专业知识;扩大她的混合方法研究技能;并过渡到一个 致力于改善老年人健康和缩小健康差距的独立调查员。 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，他们的慢性病更多，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， 并且面临着加速关闭的风险。已提出农村医院的全球预算作为一项战略， 在财政上支持农村医院，以避免关闭的风险，同时将农村医疗服务转变为最佳的 控制慢性病，缩小城乡健康差距。了解全球预算如何 实现这些成果对于了解如何加强农村卫生保健系统至关重要。 具体目标：（1）描述在获得护理、慢性病管理和相应的农村- 美国老年人的城市差异;（2）估计获得护理，慢性病 管理以及引入全球农村预算后老年人之间的城乡差异 （3）质量; 慢性 确定以医院为基础的促进者和障碍，以保持访问，改善 条件管理和缩小农村老年人的差距。 研究计划：利用健康与退休研究和医疗保险索赔，查特吉博士将首先描述 获得护理和慢性病管理的趋势，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这些 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， 了解他们为维护获取、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服务方面的专业知识 对于老年人，特别是农村社区的老年人;（2）扩大和巩固因果关系的研究技能 推理，定性方法和实施科学;（3）执行研究议程，重点是 改善患有慢性病的老年人的健康。她将在一个团队的带领下实现这些目标， 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， 一个经验丰富的多学科导师和顾问团队的指导，在以下方面有着良好的记录： 在老龄化和卫生服务研究方面培养独立的卫生服务研究人员。