Caregiving and Health Care Utilization after Stroke among Medicare Beneficiaries

描述（由申请人提供）：中风是美国严重长期残疾的主要原因。女性和非裔美国人在中风后通常有较差的功能结果，尽管这些性别和种族差异的原因尚不清楚。中风对女性和非裔美国人的不同影响可能是由不同的急性治疗和急性后康复服务以及非正式家庭照顾者的不同支持来解释的。这些因素很少在有代表性的基于人群的中风幸存者样本中进行研究。这项申请旨在寻求资金，以研究这些因素在全国样本中风幸存者谁也医疗保险受益人。照顾从卒中影响中恢复的成年人（CARES）研究是国家卒中地理和种族差异原因（REGARDS）项目的辅助研究，也是唯一一项系统收集经验证的卒中事件幸存者长期功能结局数据的研究，这些事件是在大规模、前瞻性、流行病学调查中检测到的。主要家庭照顾者也参加了CARES项目，到目前为止，已登记了210名卒中幸存者/家庭照顾者。这些中风幸存者中的大多数（N = 183，87%）是传统的医疗保险患者，其急性住院和急性后康复或恢复阶段的医疗保险索赔数据可用。卒中事件发生后约一年，在结构化的家庭评估期间评估卒中幸存者功能结局，卒中幸存者和家庭护理者的心理社会功能和生活质量通过结构化的电话访谈进行评估，从卒中事件发生后9个月开始，持续到卒中事件发生后3年。作为CARES项目扩展计划的一部分，我们将扩大纳入标准，纳入更多的卒中幸存者，包括那些没有家庭照顾者的患者，我们的总样本量将增加到420名卒中幸存者，包括365名传统的医疗保险受益人。在继续研究所有中风幸存者之间的结果差异的同时，本提案提出了新的具体目标，重点关注医疗保险索赔数据中的医疗保健利用率。以往大多数关于卒中后护理利用和卒中长期结局的研究都没有评估非正式家庭照顾者的影响或经验，我们假设照顾者可用性和参与度的差异将部分解释先前观察到的护理利用和功能结局的性别和种族差异。CARES项目具有独特的定位，可以将人口统计学变量、卒中严重程度测量、卒中后护理利用模式、非正式干预因素和长期功能结局联系起来，从而为关于女性和非裔美国人卒中后结局较差的文献增加新的知识。该项目还将促进我们对中风如何更广泛地影响患者及其家人的一般理解。 公共卫生相关性：中风是老年人常见的医疗问题。中风后的大多数正式康复护理都由传统的医疗保险索赔覆盖，大多数中风患者也接受了密切家庭成员的大量非正式护理。拟议的研究将使用全国流行病学样本来检查非正式的医疗支持、正式的医疗利用和长期卒中结局之间的联系。急性住院和急性康复后阶段的护理支持预计会因种族和性别而异，并部分解释了先前观察到的种族和性别结局差异。

DESCRIPTION (provided by applicant): Stroke is a leading cause of serious long-term disability in the United States. Women and African Americans commonly have poorer functional outcomes after stroke, although the reasons for these gender and race differences are poorly understood. Some of the differential impact of stroke on women and African Americans might be explained by differential acute treatment and post-acute rehabilitative services, and by differential support of informal family caregivers. These factors have rarely been studied in representative population- based samples of stroke survivors. This application seeks funding to study these factors in a national sample of stroke survivors who are also Medicare beneficiaries. The Caring for Adults Recovering from the Effects of Stroke (CARES) study is an ancillary study of the national REasons for Geographic and Racial Differences in Stroke (REGARDS) project and is the only study of its kind that is systematically collecting long-term functional outcome data from the survivors of verified incident stroke events that are detected in a large-scale, prospective, epidemiologic investigation. Primary family caregivers are also enrolled in the CARES project, and to date, 210 stroke survivor/ family caregiver dyads have been enrolled. Most of these stroke survivors (N = 183, 87%) are traditional Medicare beneficiaires for whom Medicare claims data for the acute hospitalization and post-acute rehabilitative or recovery phase are available. Stroke survivor functional outcomes are assessed during structured in-home evaluations approximately one year after the incident stroke events, and stroke survivor and family caregiver psychosocial functioning and quality of life are assessed with structured telephone interviews beginning 9 months after the incident stroke event and continuing up to 3 years after the stroke event. As part of this proposed extension to the CARES project, we will expand our inclusion criteria to include more stroke survivors, including those without family caregivers, and our total sample size will increase to 420 stroke survivors, including 365 who are also traditional Medicare beneficiaries. While continuing to study outcome disparities among all stroke survivors, new specific aims are advanced in this proposal that focus on measures of health care utilization from the Medicare claims data. Most of the previous studies on care utilization after stroke and the long-term outcomes of stroke have not assessed the influences or experiences of informal family caregivers, and we hypothesize that differences in caregiver availability and involvement will partially explain previously observed gender and race differences in care utilization and functional outcomes. The CARES project is uniquely positioned to link demographic variables, stroke severity measures, post-stroke care utilization patterns, informal caregiving factors, and long-term functional outcomes in ways that will add new knowledge to the literature on why women and African Americans have poorer outcomes after stroke. The project will also advance our general understanding of how stroke affects both patients and their families more broadly. PUBLIC HEALTH RELEVANCE: Stroke is a common medical problem for older adults. Most of the formal rehabilitative care after stroke is covered by traditional Medicare claims, and most stroke patients also receive considerable informal care from close family members. The proposed research will examine the links between informal caregiving support, formal care utilization, and long-term stroke outcomes using a national epidemiologic sample. Caregiving supports during the acute hospitalization and post-acute rehabilitative phases are expected to differ by race and gender, and to partially account for previously observed race and gender differences in outcomes.