Neighborhood transportation vulnerability and geographic patterns of diabetes-related limb loss

社区交通脆弱性和糖尿病相关肢体丧失的地理模式

• 批准号: 10680610
• 负责人: Howard H Chang
• 金额: $ 23.48万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-09 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680610
• 关键词: Accounting; Adult; Age; Ambulatory Care; Ambulatory Surgical Procedures; Amputation; Appointment; Area; Caring; Censuses; Chronic Disease; Clinic; Clinical; Complications of Diabetes Mellitus; County; Data; Data Sources; Databases; Development; Diabetes Mellitus; Diabetic Foot Ulcer; Disease; Disease Outcome; Disease model; Electronic Health Record; Emergency department visit; End stage renal failure; Epidemiology; Equitable healthcare; Ethnic Origin; Face; Feasibility Studies; Geographic Information Systems; Geography; Goals; Health; Health Care Costs; Health Expenditures; Health Insurance; Health Services Accessibility; Health care facility; Health system; Healthcare; Healthcare Systems; Hospitalization; Hospitals; Hyperglycemia; Incidence; Insurance; Insurance Coverage; Intervention; Knowledge; Link; Location; Low income; Lower Extremity; Maps; Measures; Mediator; Medical; Medical Records; Minor; Minority Groups; Modeling; Modification; Multi-Hospital Systems; Myocardial Infarction; National Institute on Minority Health and Health Disparities; Neighborhoods; Outcome; Outpatients; Patients; Pattern; Persons; Policies; Population Study; Prevalence; Provider; Public Hospitals; Race; Records; Research; Resources; Services; Stroke; Surveys; System; Transportation; Transportation of Patients; Ulcer; United States; Visit; barrier to care; built environment; cost; data resource; diabetes control; economic determinant; economic indicator; experience; health care availability; health care disparity; health determinants; hospital bed; improved; limb loss; patient population; people of color; primary outcome; racial minority population; secondary outcome; sex; social; social health determinants; socioeconomics; spatial epidemiology; telehealth; transportation access; wound care

Transportation is paramount to health care access and minority populations face disproportionate transportation barriers in the United States (US). Health insurance coverage expansion has been the focus to achieve equitable health care in the US, but insurance alone does not guarantee access to care unless patients and providers can interact. Sixty percent of adults in the US have ≥1 chronic disease and current models of chronic disease care require frequent and ongoing contacts between patients and healthcare systems. Despite the advent of telehealth, most patient-provider interactions require patient transportation to a healthcare facility. US national-level surveys estimate 5.8 million people missed a health care appointment in 2017 due to transportation barriers and people of color face bigger transportation barriers to care. Our goal is to investigate the associations between “transportation vulnerability” and chronic disease outcomes at the neighborhood-level and to measure how race/ethnicity, sex, and age modify the magnitude of these associations using diabetic foot ulcers (DFUs) as a chronic disease model. “Transportation vulnerability” can arise from a combination of lacking transportation resources in an area, and from poor linkage between these resources and healthcare locations. Population-based studies linking transportation vulnerability to health outcomes are lacking. We choose DFU as model because they are a devastating diabetes complication preceding most of the 100,000 diabetes-related lower extremity amputations performed yearly in US. Low- income and racial minority groups experience higher burdens of DFUs and amputations. Importantly, the progression from ulceration to amputation is preventable with adequate outpatient care and DFUs have a clear poor outcome definition in the form of limb loss. Supported by a feasibility study, we will begin to fill this knowledge gap in this exploratory study by estimating the associations between transportation vulnerability and DFU outcomes using Georgia state-wide hospital billing databases, 2016-2020 (aim 1) and detailed patient- level records of two Atlanta-based large health systems, 2016-2021 (aim 2). This offers a unique opportunity to assess robustness of our findings from these two data sources with different advantages. Our research team has clinical expertise in DFUs, as well as chronic disease epidemiology, geographic information systems, and spatial epidemiology. This study is in line with the NIMHD research model by examining the intersection of the built environment and health care systems on health outcomes. Once in place, the framework developed will be extended to investigate the associations of transportation vulnerability and major diabetes complications (myocardial infarction, stroke, end-stage renal disease, and hyperglycemic crisis in addition to amputations) at a national-level. Our long-term goal is to develop a neighborhood-level US transportation vulnerability map to inform local interventions (e.g., allocation of non-emergency medical transportation services) and regional policies (e.g., development and improvement of public transit) to close disparities in healthcare access.

交通对于获得医疗保健至关重要，少数民族人口面临着不成比例的问题

项目成果

Executive Summary: Evaluation and Management of Diabetes-related Foot Infections.

执行摘要：糖尿病相关足部感染的评估和管理。

• DOI: 10.1093/cid/ciad429
• 发表时间: 2023
• 期刊: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
• 作者: Cortes-Penfield,NicolasW;Armstrong,DavidG;Brennan,MeghanB;Fayfman,Maya;Ryder,JonathanH;Tan,Tze-Woei;Schechter,MarcosC
• 通讯作者: Schechter,MarcosC