Barriers to care for chronically ill vulnerable children

照顾患有慢性病的弱势儿童的障碍

• 批准号: 6480945
• 负责人: MICHAEL SEID
• 金额: $ 9.9万
• 依托单位: RADY CHILDREN'S HOSPITAL - SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-03-01 至 2004-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6480945
• 关键词: child (0-11); children; health care quality; health care service availability; health care service evaluation; health care service utilization; human subject; interview; pediatrics; quality of life; questionnaires; racial /ethnic difference

DESCRIPTION (APPLICATION ABSTRACT): Timely receipt of quality health care is important to the health of America?s children and even more so for children with special needs (CSHCN). However, for children in general and for CSHCN, disparities across vulnerability factors, such as race/ethnicity, SES, and language ability exist in relation to health care access, utilization, experiences, and outcomes. Our conceptual model posits that 1) vulnerability factors are associated with barriers to care, 2) these barriers to care affect access to, use of, and experiences of care, and 3) these barriers to care explain part of the observed health disparities. Developing a measure of barriers to care is a first step in testing this model. The main objective of the proposed research is to identify and measure modifiable barriers to care that affect the link between vulnerability factors, on the one hand, and health care structures, processes, and outcomes for CSHCN on the other. The specific aim of the proposed research is to develop and test a barriers to care questionnaire in English and Spanish. This will be accomplished using focus groups, cognitive interviews, and field testing in an existing sample of vulnerable CSHCN. The proposed research contributes new knowledge, specifically in the conceptualization and operationalization of the construct of barriers to care. Previous research has tended to view barriers to care as unidimensional, has tended to focus on barriers? impact on only one aspect of the health care process, and has tended to view SES and race/ethnicity as explanatory variables. The conceptualization of barriers to care as a multidimensional construct, as potentially impacting children?s health care at several points in the care process, and as distinct from, yet related to SES and race/ethnicity engenders a more robust, practical, and actionable understanding of the construct of barriers to care. A practical, reliable, and valid measure of barriers to care will be useful to many stakeholders in pediatric health care. Such a measure will support consumer choice by giving voice to patients? and parents? experiences with the care system. It will enhance accountability by giving providers and policymakers a tool for comparison and benchmarking. It will spur quality improvement by providing researchers and health care decision-makers a foundation for developing empirically-based interventions to improve the HRQL of vulnerable children. In this way, the proposed research could play a part in contributing to the nation?s goal of eliminating health disparities as described in the Public Health Service?s Healthy People 2010.

描述（应用摘要）：及时获得优质医疗保健是 对美国人的健康很重要吗对孩子们来说更是如此 有特殊需要（CSHCN）。然而，对于一般儿童和CSHCN， 脆弱性因素之间的差异，如种族/民族，社会经济地位， 语言能力与获得、利用 经验和成果。我们的概念模型假设1）脆弱性 因素与护理障碍有关，2）这些护理障碍影响 获得、利用和经历护理，以及3）这些护理障碍 解释了观察到的健康差异的一部分。制定一项措施， 护理障碍是检验这一模式的第一步。的主要目标 拟议的研究是确定和衡量可改变的护理障碍， 一方面，影响脆弱性因素之间的联系， 另一方面，CSHCN的医疗保健结构、过程和结果。的 拟议研究的具体目标是开发和测试一种屏障， 英文和西班牙文的护理问卷。这将通过使用 焦点小组，认知访谈，并在现有样本的实地测试， 脆弱的CSHCN拟议的研究贡献了新的知识， 特别是在概念化和操作化的建设 的障碍。以前的研究倾向于将护理障碍视为 一维的，倾向于关注障碍吗？只影响到一个方面 医疗保健过程，并倾向于将SES和种族/民族视为 解释变量护理障碍的概念化， 多维结构，作为潜在的影响儿童？卫生保健. 护理过程中的几个要点，与SES和种族/民族不同但又相关，产生了更强大、实用和可操作的 理解护理障碍的构成。一个实用，可靠， 和有效措施的障碍，以照顾将是有益的许多利益相关者， 儿科保健。这项措施将支持消费者的选择， 患者的声音？还有父母护理系统的经验。它将 加强问责制，为供应商和决策者提供一个工具， 比较和基准。它将通过提供 研究人员和卫生保健决策者的基础， 以医疗为基础的干预措施，以改善弱势儿童的HRQL。 通过这种方式，拟议的研究可以在促进 国家？的目标，消除健康差距所描述的公众 医疗服务？2010年健康人。