Race and Medicare-Medicaid Dual Enrollment Disparities in Access to Quality and Intensity of Post-Acute Rehabilitation Care and Health Outcomes in Patients with Stroke

种族和医疗保险-医疗补助双重注册在中风患者获得急性后康复护理和健康结果的质量和强度方面存在差异

• 批准号: 10528690
• 负责人: Amit Kumar
• 金额: $ 0.2万
• 依托单位: NORTHERN ARIZONA UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-11 至 2022-12-16
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10528690
• 关键词: Accounting; Acute; Address; Admission activity; Adult; Area; Assessment tool; Caregivers; Caring; Characteristics; Clinical; Communities; Data; Data Collection; Decision Aid; Decision Making; Development; Diabetes Mellitus; Discharge Plannings; Dose; Dual Enrollment; Ethnic Origin; Evaluation; Focus Groups; Goals; Health; Health Services; Health care facility; Hospitalization; Hospitals; Hypertension; Improve Access; Individual; Inpatients; Lead; Length of Stay; Measures; Medicare; Medicare claim; Medicare/Medicaid; Methods; Occupational Therapy; Outcome; Pathway interactions; Patient-Centered Care; Patient-Focused Outcomes; Patients; Perception; Physical therapy; Population; Process; Provider; Proxy; Qualitative Methods; Quality of Care; Race; Recovery; Recovery of Function; Rehabilitation therapy; Research; Sampling; Scientific Advances and Accomplishments; Selection Bias; Severities; Speech Therapy; Stroke; Time; Underserved Population; United States; United States Centers for Medicare and Medicaid Services; Work; acute care; acute stroke; base; beneficiary; care outcomes; cohort; cost; design; dual eligible; ethnic minority; functional gain; functional status; health care delivery; health disparity; hospital readmission; improved; indexing; low socioeconomic status; post stroke; primary outcome; provider factors; racial and ethnic; racial disparity; racial minority; rehabilitation service; rehabilitative care; service providers; stroke outcome; stroke patient; tool

PROJECT SUMMARY Racial disparity in stroke-related care remains among the most compelling health service concerns in the United States. Stroke patients account for about 20% of all inpatient rehabilitation facility (IRF) admissions. However, there is limited research to date exploring patient-centered outcomes associated with the quality and intensity of IRF-based rehabilitation services among stroke patients who are racial/ethnic minorities and are dual eligible for Medicare and Medicaid. Our proposal uses an integrative mixed methods design to study how individual- and provider-level factors contribute to disparities in IRF quality rating and amount of therapy, and subsequently, the combined effect of the two on patient health outcomes. The qualitative aim will identify facilitators and barriers to IRF selection among racial/ethnic minorities and those with dual eligiblility after stroke and the impact of the selection of quality IRFs on patient perceptions of IRF quality of care. This study will use 100% Medicare claims and assessment data (2017-2022), and perspectives from patients/caregivers, hospital discharge planners, and rehabilitation clinicians from different regions to understand selection processes of IRF and outcomes. We will utilize the Medicare Inpatient Standard Analytical File, Beneficiary Summary, Inpatient Rehabilitation Facilities Patient Assessment Instrument, Provider of Service, and publicly available IRF Medicare compare data. Patients with ‘index stroke’ admitted directly to IRFs from acute hospitals will serve as our primary cohort. For the first three aims, a) change in functional status, b) 30-day hospital readmission, and c) community discharge will serve as primary outcomes, adjusting for patient-, hospital-, and market-level characteristics. For the fourth, qualitative aim, patient perception of IRF quality and perceived functional recovery will be primary dependent variables for assessing the impact of disparities in rehabilitation care.

项目摘要 中风相关护理的种族差异仍然是美国最引人注目的卫生服务问题之一。 States.中风患者约占所有住院康复机构（IRF）入院的20%。然而，在这方面， 到目前为止，探索以患者为中心的结果与质量和强度相关的研究有限。 在少数种族/民族卒中患者中提供基于IRF的康复服务， 医疗保险和医疗补助。我们的建议使用一个综合的混合方法设计，研究如何个人和 提供者层面的因素导致IRF质量评级和治疗量的差异，随后， 两者对患者健康结果的综合影响。定性目标将确定促进因素和障碍 IRF在少数种族/民族和卒中后双重致死性患者中的选择以及 根据患者对IRF护理质量的感知选择高质量IRF。 这项研究将使用100%的医疗保险索赔和评估数据（2017-2022年），以及来自 来自不同地区的患者/护理人员、出院计划人员和康复临床医生， 综合资源框架的甄选过程和成果。我们将利用医疗保险住院病人标准分析文件， 受益摘要，住院康复设施患者评估工具，服务提供商，以及 公开的IRF Medicare比较数据。从急性脑卒中直接进入IRF的“索引卒中”患者 医院将作为我们的主要队列。对于前三个目标，a）功能状态改变，B）30天 再入院，和c）社区出院将作为主要结果，调整患者， 医院级和市场级特征。第四，定性目标，患者对IRF质量的感知， 感知的功能恢复将是评估差异影响的主要因变量， 康复护理。