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。女性和非裔美国人中风后的功能结果通常较差，尽管人们对这些性别和种族差异的原因知之甚少。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。这些因素很少在中风幸存者的代表性人群样本中进行研究。这项申请寻求资金来研究这些因素在全国样本中风幸存者谁也是医疗保险受益人。照顾中风后恢复的成年人（CARES）研究是国家中风地理和种族差异原因（REGARDS）项目的辅助研究，也是同类研究中唯一一项系统地收集经大规模前瞻性流行病学调查发现的经证实的突发中风事件幸存者的长期功能结果数据的研究。主要家庭照顾者也参加了CARES项目，迄今为止，已有210名中风幸存者/家庭照顾者夫妇参加了该项目。这些中风幸存者中的大多数（N = 183,87%）是传统的医疗保险受益人，他们的医疗保险索赔数据可用于急性住院和急性后康复或恢复阶段。中风幸存者的功能结果在中风事件发生大约一年后的结构化家庭评估中进行评估，中风幸存者和家庭照顾者的社会心理功能和生活质量在中风事件发生9个月后开始进行结构化电话访谈，并持续到中风事件发生后3年。作为CARES项目拟议扩展的一部分，我们将扩大纳入标准，纳入更多中风幸存者，包括那些没有家庭照顾者的人，我们的总样本量将增加到420名中风幸存者，其中包括365名也是传统医疗保险受益人的人。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，即关注医疗保险索赔数据中医疗保健利用的措施。大多数关于中风后护理利用和中风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，我们假设照顾者的可用性和参与的差异将部分解释先前观察到的性别和种族在护理利用和功能结局方面的差异。CARES项目的独特定位是将人口统计变量、中风严重程度测量、中风后护理利用模式、非正式护理因素和长期功能结果联系起来，从而为有关女性和非裔美国人中风后预后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属的一般理解。

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.