Improving the Health of Low-SES Americans Approaching Retirement Under the Affordable Care Act

根据《平价医疗法案》改善即将退休的低社会经济地位美国人的健康

• 批准号: 9370582
• 负责人: Renuka Tipirneni
• 金额: $ 16.68万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9370582
• 关键词: Adult; Affordable Care Act; Age; Aging; Alcohol or Other Drugs use; Ambulatory Care; American; Award; Behavioral; Cardiovascular Diseases; Caring; Cessation of life; Characteristics; Chronic; Chronic Disease; Clinical; Data; Development Plans; Diabetes Mellitus; Disease Management; Economics; Elements; Eligibility Determination; Environment; Evaluation; Exhibits; Face; Foundations; Funding; Goals; Health; Health Care Costs; Health Insurance; Health Policy; Health Services; Health Services Accessibility; Health and Retirement Study; Healthcare; Healthcare Systems; Heterogeneity; Home environment; Impairment; Improve Access; Income; Inequality; Institutes; Insurance; Internist; Interview; Life Cycle Stages; Life Expectancy; Link; Longitudinal Surveys; Low income; Medicaid; Medical; Medicare; Medicare claim; Medicare/Medicaid; Mental Health; Mentors; Mentorship; Methods; Michigan; Morbidity - disease rate; Natural experiment; Outcome; Physical Function; Policies; Positioning Attribute; Premature aging syndrome; Psyche structure; Quality of life; Research; Research Methodology; Research Personnel; Respondent; Retirement; Risk; Risk Factors; Sampling; Social Work; Socioeconomic Status; Stress; Testing; Time; Time trend; Training; Universities; Visit; Vulnerable Populations; Work; care delivery; career; career development; chronic pain; cohort; cost; critical period; depressive symptoms; design; experience; experimental analysis; health care delivery; health care service utilization; high risk; improved; innovation; low socioeconomic status; meetings; modifiable risk; mortality; physical conditioning; profiles in patients; programs; research and development; success

PROJECT SUMMARY / ABSTRACT Candidate: Renuka Tipirneni, MD, MSc is a general internist and junior health services researcher focused on improving the health care system for prematurely aging low socioeconomic status (SES) adults approaching retirement age. Dr. Tipirneni's long-term career objective is to become an independent mixed methods investigator integrating large-scale clinical and economic data with in-depth qualitative data to inform the design and evaluation of policies and programs to improve the health of low-SES aging adults. Research Context: Low-SES Americans approaching retirement face a crisis of poor health and markedly increasing mortality. Between 2001 and 2014, disparities in life expectancy between low- and high-SES adults near retirement have widened and this may have accounted for 500,000 excess deaths. Yet the drivers of this crisis are poorly understood. The Affordable Care Act (ACA) should improve access to care through insurance expansions and care delivery innovations and help this group manage chronic conditions and improve their health. However, it is not clear how low-SES aging adults are specifically benefitting from ACA policies, which groups should be principally targeted for new care delivery programs encouraged under the ACA, and what factors are associated with successful health improvement and decreased costs for at-risk aging Americans. Specific Aims: 1) Determine changes in coverage, access, utilization, health and financial stress for low-SES 55-64-year-olds before and after the ACA Medicaid expansion; 2) Classify sub-groups of low-SES 55-64-year- olds at highest risk of poor health and characterize heterogeneity of changes in access, utilization, health and costs in identified high-risk sub-groups; 3) Identify facilitators of and barriers to improvements in health outcomes and health care utilization among high-risk low-SES aging adults in an ACA care delivery program. Research Plan: To accomplish these aims, Dr. Tipirneni will perform quasi-experimental analyses with the Health and Retirement Study to assess health and health care changes before and after the ACA. She will then identify sub-groups of low-SES near retirement adults at high risk of poor health trajectories. Lastly, she will conduct qualitiatve interviews with low-SES near retirement adults in an ACA care delivery program to identify facilitators of and barriers to health improvement and decreased high-cost utilization. Career Development Plan: Dr. Tipirneni will develop expertise in 1) analysis of large-scale longitudinal survey and administrative data; 2) application of quasi-experimental approaches to evaluate programs; 3) mixed methods research; and 4) programmatic research focused on aging adults. Dr. Tipirneni's career development goals will be supported by close mentorship from an interdisciplinary team; advanced didactic coursework; participation in research and career development meetings/seminars; and ongoing guidance in her research. Environment: The University of Michigan offers the ideal environment for her to pursue this training, with the outstanding guidance of well-established mentors and interdisciplinary institutes dedicated to her success.

项目摘要/摘要 候选人：Renuka Tipirneni，医学博士，理学硕士，普通内科医生和初级卫生服务研究员，专注于 改善早衰低社会经济地位(SES)成年人临近的医疗保健系统 退休年龄。蒂皮尔内尼博士的长期职业目标是成为一名独立的混合方法 研究人员将大规模的临床和经济数据与深入的定性数据相结合，为 设计和评估政策和计划，以改善低社会经济地位老年人的健康。 研究背景：接近退休的美国人面临健康状况不佳和明显 死亡率不断上升。2001至2014年间，低社会保障指数和高社会保障指数成年人之间的预期寿命差异 接近退休的人数有所增加，这可能解释了50万人的额外死亡。然而，这一切的驱动力 人们对危机知之甚少。《平价医疗法案》(ACA)应改善通过保险获得医疗服务的机会 扩展和护理提供创新，并帮助这一群体管理慢性病并改善其 健康。然而，目前尚不清楚低SES老年人如何具体受益于ACA政策，即 根据ACA鼓励的新的护理提供计划应该主要针对群体，以及什么 这些因素与成功改善健康状况和降低高危老龄化美国人的成本有关。 具体目标：1)确定低SES的覆盖范围、准入、利用率、健康和财务压力方面的变化 55岁--ACA医疗补助扩大前后；2)分类-SES低分组55--岁- 老年人健康状况不佳的风险最高，并表现出获取、利用、健康和健康变化的异质性 确定高危人群的费用；3)确定改善健康的促进者和障碍 ACA护理服务项目中高风险、低SES老年成年人的结果和卫生保健利用。 研究计划：为了实现这些目标，蒂皮尔内尼博士将与 健康和退休研究，以评估ACA前后的健康和医疗保健变化。她会的 然后确定接近退休年龄、健康轨迹不佳的高风险人群的低SES亚群。最后，她 将在ACA护理提供计划中对接近退休成年人的低SES进行合格访谈，以 确定改善健康和减少高成本利用的促进者和障碍。 职业发展计划：蒂皮尔内尼博士将在1)大规模纵向调查分析方面培养专业知识 和管理数据；2)应用准实验方法评估方案；3)混合 方法研究；4)以老年人为重点的程序性研究。蒂皮尔内尼博士的职业发展 目标将得到来自跨学科团队的密切指导的支持；高级教学课程； 参加研究和职业发展会议/研讨会；并持续指导她的研究。 环境：密歇根大学为她继续进行培训提供了理想的环境， 优秀的导师和跨学科机构的杰出指导，致力于她的成功。