Regulatory Reform and Angiography Disparties

监管改革与血管造影的分歧

• 批准号: 6762648
• 负责人: JOEL C CANTOR
• 金额: $ 40.54万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-08-01 至 2007-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6762648
• 关键词: African American; Hispanic Americans; angiography; cardiovascular imaging /visualization; caucasian American; clinical research; data collection; health care quality; health care service availability; health care service utilization; health disparity; health services research tag; human subject; interview; mathematical model; medically underserved population; racial /ethnic difference

DESCRIPTION (provided by applicant): Beginning in 1996, New Jersey embarked on hospital regulatory reforms that addressed, among other goals, the long-standing problem of racial and ethnic disparities in use of cardiac angiography (CA). These reforms led to a doubling in the number of hospitals performing CA as well as state-monitoring of minority outreach and access activities for CA services at each hospital. This proposal builds on AHRQ-funded pilot studies to examine the effectiveness of this innovative policy. Specific aims are to: (1) determine whether the disparity between black and white CA utilization declined following implementation of NJ policies intended to expand access for minority patients, (2) evaluate how local health system characteristics may influence CA disparities and the pathways through which the NJ policy may have reduced these disparities; and (3) identify promising strategies for reducing CA disparities. Hispanic-white CA disparities will also be investigated. Quantitative modeling and qualitative analyses will be blended to evaluate CA disparity trends from 1993-2003 in contrast to trends in a non-reform state. Primary outcome measures are the white-black difference in age-sex adjusted CA rates in small areas and the volume and share of CA utilization by black patients at NJ hospitals that provided CA throughout the study period. Regression methods will be used to adjust for market area demographics and other factors. Hypotheses about the effects of changes in CA capacity and hospital competition will be tested. CA facilities that demonstrate higher-than-expected levels of service to black patients, based on regression models, will be selected for intensive case studies along with a set of matched comparison facilities that are not high performing. The case studies will be focused on the market areas of the selected facilities, and will include documentary review and semi-structured interviews of officials from the selected CA facilities, referring hospitals, community health centers and other players in the case markets. Research findings will be translated to the practice and policy community in the form of "best practices" and through feedback of hospital-specific CA disparity performance measures.

描述(申请人提供)：从1996年开始，新泽西州开始进行医院管理改革，其中一个目标是解决长期存在的心脏血管造影术(CA)使用中的种族和民族差异问题。这些改革导致开展社区卫生服务的医院数量翻了一番，并对每家医院的社区卫生服务的少数群体外联和准入活动进行了国家监测。这项建议建立在AHRQ资助的试点研究的基础上，以检查这一创新政策的有效性。具体目标是：(1)确定在实施旨在扩大少数族裔患者机会的新泽西州政策后，黑人和白人CA使用率之间的差距是否有所下降；(2)评估当地卫生系统特征可能如何影响CA差距，以及新泽西州政策可能通过哪些途径减少这些差距；以及(3)确定减少CA差距的有希望的战略。西班牙裔白人CA的差异也将被调查。将结合定量建模和定性分析来评估1993-2003年与非改革状态下的趋势形成对比的社区卫生差异趋势。主要的结果衡量指标是在小范围内年龄-性别调整后的CA率中的白-黑差异，以及在整个研究期间提供CA的新泽西州医院黑人患者使用CA的数量和份额。将使用回归方法根据市场面积、人口统计和其他因素进行调整。关于CA能力和医院竞争变化的影响的假设将得到检验。基于回归模型，向黑人患者提供的服务水平高于预期的CA机构将被选为密集的案例研究，并将与一组表现不高的匹配比较机构一起被选中。案例研究将侧重于选定设施的市场领域，并将包括对选定的CA设施、转诊医院、社区卫生中心和案例市场其他参与者的官员进行的文献审查和半结构化访谈。研究结果将以“最佳实践”的形式并通过医院特定的CA差异表现衡量标准的反馈传递给实践和政策界。