Optimal & Equitable Care: Medicaid Data Research Infrastructure

最佳的

• 批准号: 8016135
• 负责人: GEORGE S RUST
• 金额: $ 99.41万
• 依托单位: MOREHOUSE SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2012-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8016135
• 关键词: Optimal; Equitable; Care; Medicaid; Data

DESCRIPTION (provided by applicant): Purpose: This is a Data Capacity-Building Project, to build a robust comparative effectiveness research infrastructure, agenda, and collaborative partnerships focused on eliminating health disparities. Specifically we will build a database comprised of all Medicaid enrollees and claims in the states that share in common both adverse minority health outcomes and the historical roots of racial health disparities in the South. Setting & Participants: Our CMS data request has already been approved and we have actually purchased (but not yet received) a 100% sample of four years (2004-07) of Medicaid Analytic Extract (MAX-file) data (plus Medicare-linked claims for dual-eligibles) from fourteen southern states, representing 3.8 to 5.4 million persons each year (one-third of all U.S. Medicaid enrollees, nearly half [48%] of African American and 21 % of Latino Medicaid enrollees in the U.S). This region is the epicenter of the black-white health disparities epidemic, and has also experienced a recent and rapid influx of Latino immigrants. Our HBCU-based team has previously had extensive experience training health services researchers (especially minority investigators) to use Medicaid claims data for research, but we currently lack the personnel and infrastructure support needed to efficiently organize and analyze these data to support minority investigators. Specific Alms: Using Medicaid Claims Data: 1. To build a Medicaid claims data set (including socio-economic, contextual, and geospatial analytic variables, NDC cross-walk data and therapeutic class codes, as well as certain Medicare data for dualeligibles) to support projects focused on the intersection between disparities research and comparative effectiveness research in clinically and socially complex patient populations. 2. To create an efficient process for assisting non-Morehouse investigators to develop research protocols, analysis plans, CMS data re-use requests, and analytic files for collaborative research. 3. To train, develop, cultivate, and support emerging minority investigators (especially at HBCUs and other minority-serving institutions) as independently-funded health services researchers who are increasingly proficient in multivariate analysis of Medicaid and Medicare claims data. 4. Cultivate comparative effectiveness and disparities research collaborations with Georgia Tech experts in mathematics, complexity science, simulation modeling, and interactive computing. PUBLIC HEALTH RELEVANCE: Medicaid patients are characterized by clinical and social complexity - the very characteristics that often exclude them from clinical trials and yet drive health disparities. This Medicaid based data set will populate studies that help us understand how local-area, provider-level, and patient-level differences in treatment (natural experiments in comparative effectiveness) influence clinical and economic outcomes. Variation implies that disparities are not inevitable. The comparative impact of this natural variation can be measured in meaningful outcomes such as emergency department visits, hospital admissions, inpatient bed-days, deaths, and total Medicaid expenditures, as well as community-level disparity rate-ratios. Medicaid data allow us to follow a complex patient (e.g., co-morbid diabetes and schizophrenia or COPD and CHF) from treatment to outcomes through every billable service in the healthcare system {i.e., from doctor's visit to lab tests to prescriptions to emergency room visits or hospital admissions). Morehouse School of Medicine has a unique ability to develop a new cadre of minority investigators to conduct and interpret the results of health services research with a racially-sensitive, culturally-competent perspective.

目的：这是一个数据能力建设项目，旨在建立一个强大的比较有效性研究基础设施，议程和合作伙伴关系，重点是消除健康差距。具体来说，我们将建立一个数据库，其中包括各州的所有医疗补助注册者和索赔，这些数据库共同分享了不利的少数民族健康结果和南方种族健康差异的历史根源。 设置参与者（& P）：我们的CMS数据请求已经获得批准，我们已经购买了（但尚未收到）四年（2004-07）的100%医疗补助分析摘录样本（MAX文件）数据（加上与医疗保险有关的双重死亡索赔），每年代表380万至540万人（占美国所有医疗补助注册者的三分之一，近一半[48%]的非洲裔美国人和21%的拉丁美洲医疗补助注册者）。该地区是黑人与白人健康差距流行病的中心，最近也经历了拉丁美洲移民的快速涌入。我们的HBCU团队此前在培训卫生服务研究人员（特别是少数民族调查人员）使用医疗补助索赔数据进行研究方面拥有丰富的经验，但我们目前缺乏有效组织和分析这些数据以支持少数民族调查人员所需的人员和基础设施支持。 具体施舍：使用医疗补助索赔数据：1.建立一个医疗补助索赔数据集（包括社会经济，背景和地理空间分析变量，NDC交叉数据和治疗类代码，以及某些医疗保险数据dualkillbles），以支持专注于临床和社会复杂患者人群差异研究和比较有效性研究之间的交叉点的项目。2.创建一个有效的流程，以协助非莫尔豪斯研究人员制定研究方案，分析计划，CMS数据重用请求和分析文件，以进行合作研究。3.培训，发展，培养和支持新兴的少数民族调查人员（特别是在HBCU和其他少数民族服务机构）作为独立资助的卫生服务研究人员，他们越来越精通医疗补助和医疗保险索赔数据的多变量分析。4.培养与格鲁吉亚技术专家在数学，复杂性科学，仿真建模和交互式计算的比较有效性和差距研究合作。 公共卫生关系：医疗补助患者的特点是临床和社会复杂性-正是这些特点往往将他们排除在临床试验之外，但却导致健康差异。这个基于医疗补助的数据集将填充研究，帮助我们了解当地，提供者水平和患者水平的治疗差异（比较有效性的自然实验）如何影响临床和经济结果。差异意味着差异并非不可避免。这种自然变化的比较影响可以通过有意义的结果来衡量，如急诊室就诊、住院、住院天数、死亡和医疗补助总支出，以及社区水平的差异率比。医疗补助数据使我们能够跟踪复杂的患者（例如，共病的糖尿病和精神分裂症或COPD和CHF）通过医疗保健系统中的每一个可计费服务从治疗到结果（即，从医生的访问到实验室测试到处方到急诊室访问或住院）。莫尔豪斯医学院有一个独特的能力，开发一个新的少数民族调查干部进行和解释卫生服务研究的结果与种族敏感，文化能力的角度。

项目成果

Diversity in academic medicine no. 3 struggle for survival among leading diversity programs.

学术医学的多样性没有。

• DOI: 10.1002/msj.20081
• 发表时间: 2008
• 期刊: The Mount Sinai journal of medicine, New York
• 作者: Strelnick,AHal;Taylor,VeraS;Williams,Beverly;Lee-Rey,Elizabeth;Herbert-Carter,Janice;Fry-Johnson,YvonneW;Smith,QuentinT;Rust,George;Kondwani,Kofi
• 通讯作者: Kondwani,Kofi

Racial/ethnic disparities, social support, and depression: examining a social determinant of mental health.

种族/民族差异、社会支持和抑郁：检查心理健康的社会决定因素。

• 发表时间: 2012
• 期刊: Ethnicity & disease
• 影响因子: 3.2
• 作者: Shim,RuthS;Ye,Jiali;Baltrus,Peter;Fry-Johnson,Yvonne;Daniels,Elvan;Rust,George
• 通讯作者: Rust,George

Perceptions of health care communication: examining the role of patients' psychological distress.

对医疗保健沟通的看法：检查患者心理困扰的作用。

• DOI: 10.1016/s0027-9684(15)30779-3
• 发表时间: 2010
• 期刊: Journal of the National Medical Association
• 影响因子: 3.3
• 作者: Ye,Jiali;Shim,Ruth
• 通讯作者: Shim,Ruth

Potential savings from increasing adherence to inhaled corticosteroid therapy in Medicaid-enrolled children.

增加参加医疗补助的儿童对吸入皮质类固醇治疗的依从性可能会节省费用。

• 发表时间: 2015
• 期刊: The American journal of managed care
• 作者: Rust,George;Zhang,Shun;McRoy,Luceta;Pisu,Maria
• 通讯作者: Pisu,Maria

Individual and county level predictors of asthma related emergency department visits among children on Medicaid: A multilevel approach.

• DOI: 10.1080/02770903.2016.1196367
• 发表时间: 2017-01-02
• 期刊: The Journal of asthma : official journal of the Association for the Care of Asthma
• 作者: Baltrus P;Xu J;Immergluck L;Gaglioti A;Adesokan A;Rust G
• 通讯作者: Rust G