Veteran Socioeconomic Status: Development and Validation of a Novel Measure to Support a Learning Healthcare System

退伍军人社会经济地位：支持学习医疗保健系统的新措施的开发和验证

• 批准号: 9610346
• 负责人: Elizabeth Tarlov
• 金额: --
• 依托单位: EDWARD HINES JR VA HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9610346
• 关键词: Address; American; Aptitude; Aptitude Tests; Area; Caring; Censuses; Clinical; Code; Community Surveys; Comorbidity; Data; Data Sources; Department of Defense; Development; Diabetes Mellitus; Economics; Education; Elderly; Elements; Eligibility Determination; Exhibits; Future; General Population; Glycosylated hemoglobin A; Goals; Health; Health Insurance; Health Services Accessibility; Health behavior; Health system; Healthcare; Healthcare Systems; Income; Individual; Insurance Coverage; Investigator-Initiated Research; Learning; Life; Link; Low income; Measurement; Measures; Medical; Methods; Military Personnel; Modeling; Monitor; Occupational; Outcome; Patients; Performance; Persons; Pilot Projects; Population; Productivity; Provider; Proxy; Race; Regression Analysis; Research; Research Proposals; Resource Allocation; Resources; Retrospective Studies; Risk Adjustment; Role; Sampling; Series; Services; Smoking Status; Socioeconomic Status; Subgroup; Surveys; System; Tail; Testing; Training; Universal Coverage; Validation; Veterans; Work; base; care outcomes; cognitive ability; copayment; data resource; expectation; experience; health care availability; health care delivery; health care service; health disparity; health equity; improved; indexing; individual variation; innovation; interest; learning progression; low socioeconomic status; novel; operation; patient population; recruit; research study; safety net; social; socioeconomics

Background. Decades of research indicates people with less education and lower income have worse health, receive fewer needed services, and often have poorer healthcare outcomes, even in populations with universal coverage. Despite VA's role as a safety-net provider and commitment to equity, the limited evidence available suggests that higher socioeconomic status (SES) is associated with better outcomes in VA, as elsewhere. Patient SES may also influence health system performance. But this is difficult to track because the VA, like other health systems, does not routinely collect information on income or other SES measures. Currently, research studies and VA analyses use indirect proxy measures based on VA priority group or census data that are only rough approximations of individual SES. There is a need for a better measure. Specific Aims. The objective of this pilot study application is to evaluate the potential value and limitations of a newly available data source as an individual-level proxy for measures of SES. The Armed Services Vocational Aptitude Battery (ASVAB) is a series of tests administered to military enlistees at recruitment. Given the close correlation between aptitude test scores, which reflect a person's cognitive ability, and later life educational attainment, income, and wealth, Veterans' ASVAB results may be useful in capturing elements of SES for research, performance measurement, and other uses. The aims of this pilot study are: (1) Examine the VA population coverage, representativeness, and quality of the ASVAB data; (2) Using two distinct analytic subsamples and two income data sources, a) examine relationships between Veterans' ASVAB scores measured at enlistment and their present-day income, and b) assess the representativeness of the subsamples in regard to ASVAB-income relationships; and (3) determine whether ASVAB scores have added value in explaining individual variation in selected measures of current health and health behaviors (functional limitations, comorbidity burden, hemoglobin A1c in those with diabetes, and smoking status). Significance. The proposed research is well-aligned with HSR&D and VHA priorities: developing new measurement approaches for becoming a high-performing, continuously learning healthcare system, healthcare equity & health disparities, and improving Veterans' access to care. A better individual-level SES measure would have multiple important uses in VA, including in improving performance measurement to take patient SES into account and the predictive ability of models determining resource allocation, productivity expectations, and future access and capacity. Innovation. This study is highly innovative because it creatively addresses a major barrier to research, quality and performance measurement, and assessment and monitoring of equity in healthcare access and outcomes: lack of information on patient SES. The study does so by taking advantage of a promising new data resource—ASVAB scores—that was not previously evaluated for use to support Veterans later in life. Methods. The population is Veterans using VA healthcare services in 2010-2017. This will be a retrospective study using existing VA, American Community Survey, and Department of Defense ASVAB data. Veteran income data will come from the Annual Survey of Veteran Enrollees' Health and Healthcare and the VA's Health Eligibility Center (HEC). Descriptive and multivariable regression analyses will be conducted. Expected Results. This project will provide an understanding of the strengths and limitations of the data and evidence to assess whether the ASVAB-income relationships measured in available samples will hold in the broader VA population and ASVAB data will provide value-added to current measurement approaches. Next Step(s). Based on the results of this work, we plan to submit an Investigator-Initiated Research proposal (IIR) to develop and evaluate an SES index based on ASVAB scores and assess its value for risk adjustment in performance measurement.

背景资料。几十年的研究表明，受教育程度较低、收入较低的人健康状况较差， 获得的所需服务较少，而且往往医疗保健结果较差，即使在有 全民覆盖。尽管退伍军人事务部扮演着安全网提供者的角色，并致力于公平，但证据有限 Available表明，较高的社会经济地位(SES)与退伍军人管理局(VA)的结果更好相关，因为 其他地方。患者的SES也可能影响卫生系统的性能。但这很难追踪，因为 退伍军人管理局和其他卫生系统一样，不定期收集有关收入或其他社会保障措施的信息。 目前，研究和VA分析使用基于VA优先组或 人口普查数据只是对个别社会经济状况的粗略估计。有必要采取更好的措施。 明确的目标。这一试点研究应用的目的是评估潜在的价值和局限性 一个新的可用的数据源，作为衡量SES的个人级别的代理。三军 职业能力测验(ASVAB)是在应征入伍时对应征军人进行的一系列测试。 考虑到反映一个人认知能力的能力倾向测试分数与后来的 终身教育程度、收入和财富，退伍军人的ASVAB结果可能有助于捕捉元素 用于研究、性能测量和其他用途的SES。这项初步研究的目的是：(1)检查 退伍军人事务部人口覆盖率、代表性和ASVAB数据的质量；(2)使用两种不同的分析 子样本和两个收入数据来源，a)检查退伍军人ASVAB分数之间的关系 在入伍时衡量的，以及他们目前的收入；b)评估 关于ASVAB-收入关系的子样本；以及(3)确定ASVAB得分是否增加 在解释当前健康和健康行为的选定测量中的个体差异方面的价值(功能 限制、共病负担、糖尿病患者的血红蛋白A1c和吸烟状况)。 意义重大。拟议的研究与HSR&D和VHA的优先事项非常一致：开发新的 成为高性能、持续学习的医疗保健系统的衡量方法， 医疗公平和健康差距，以及改善退伍军人获得医疗保健的机会。更好的个人层面的SES 测量将在VA中有多个重要用途，包括改进要采取的绩效测量 考虑患者SES和决定资源分配、生产力的模型的预测能力 期望值，以及未来的准入和能力。 创新。这项研究具有很高的创新性，因为它创造性地解决了研究的主要障碍--质量 和绩效衡量，以及评估和监测医疗保健服务的公平性和 结果：缺乏关于患者SES的信息。这项研究是通过利用一项有前景的新数据来实现的 资源-ASVAB分数-以前没有被评估用于支持退伍军人以后的生活。 方法：研究方法。人口是2010-2017年间使用退伍军人医疗服务的退伍军人。这将是一次回顾展 使用现有的退伍军人事务部、美国社区调查和国防部ASVAB数据进行研究。老兵 收入数据将来自退伍军人健康和医疗保健年度调查以及退伍军人管理局 健康资格中心(HEC)。将进行描述性和多变量回归分析。 预期结果。本项目将提供对数据的优势和局限性的理解，并 评估在现有样本中测量的ASVAB-收入关系是否适用于 更广泛的VA人口和ASVAB数据将为当前的衡量方法提供增值。 下一步(S)。根据这项工作的结果，我们计划提交一份由调查人员发起的研究提案 (IIR)根据ASVAB分数开发和评估SES指数，并评估其风险调整价值 在绩效衡量方面。