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Physician Networks for Diabetic Lower Extremity Wounds

糖尿病下肢伤口的医生网络

基本信息

批准号：
10710527
负责人：
CHERYL DAMBERG
金额：
$ 89.71万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-28 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10710527
关键词：
Accident and Emergency department Address Adult Affect Ambulatory Care Amputation Asian Black Populations Caring Characteristics Classification Clinical Communities Community Healthcare Community Physician Data Data Sources Development Diabetes Mellitus Diagnosis Disparity Elderly Ethnic Origin Evaluation Fee-for-Service Plans Financial Hardship Foundations Funding Future Geographic Locations Geography Goals Health Disparities Research Health Services Health Services Research Health system Hispanic Populations Hospital Referrals Hospitals Incentives Infrastructure Insurance Claim Review Intervention Knowledge Low income Lower Extremity Maps Measurement Medical Medicare Medicare/Medicaid Methods Minority Groups Minority Health Research Modification Morbidity - disease rate Outcome Pacific Islander Pathway Analysis Patient Care Patient-Focused Outcomes Patients Pattern Performance Physician&apos s Role Physicians Play Policies Poverty Process Public Health Quality of Care Race Research Research Personnel Resources Role Science Services Skilled Nursing Facilities Social Network Specialist Statistical Methods Techniques United States Agency for Healthcare Research and Quality United States National Institutes of Health Visit Work aged beneficiary care coordination care costs density diabetic disparity reduction dual eligible effective intervention ethnic disparity evidence base follow-up health care disparity health care service utilization human old age (65+)improved innovation medical specialties minority health minority health disparity mortality multidisciplinary novel strategies patient home care prevent provider factors racial disparity segregation socioeconomic disadvantage socioeconomic disparity socioeconomics therapy development wound wound care wound healing

项目摘要

Summary/Abstract Diabetic lower extremity (DLE) wounds affect up to 34% of adults with diabetes and are associated with substantial clinical morbidity/mortality, increased healthcare utilization, and higher cost of care. However, persistent racial/ethnic and socioeconomic disparities among DLE wounds remain poorly addressed, and little is known about the utilization of physician services and role of physician networks in observed disparities. This proposal responds to PAR-20-310, Health Services Research on Minority Health and Health Disparities, by conducting a national evaluation of racial/ethnic and socioeconomic disparities in healthcare utilization among patients with DLE wounds, and assessing the role that physician networks and referral patterns play in observed disparities. Through the RAND AHRQ U19 Center of Excellence on Health System Performance, our study will leverage several Medicare data sources, unique physician-level preliminary data, and innovative methods to improve beneficiary classification of race/ethnicity. The study will focus on Medicare fee-for-service beneficiaries aged 65 years and older with a new DLE wound and track longitudinal utilization of healthcare services across multiple clinical settings during the 6-month period following initial wound diagnosis. In Aim 1, we will use multivariable regression techniques to evaluate racial/ethnic and socioeconomic disparities in healthcare utilization after initial DLE wound diagnosis. Then, we will map and characterize physician networks and referral patterns for DLE wounds and examine the effects of network/referral pattern characteristics on healthcare utilization disparities (Aim 2). Finally, in Aim 3, we will simulate changes to network/referral pattern characteristics and identify which characteristics have stronger disparity reducing effects, and therefore, are amenable to intervention development. The proposed study will identify potentially modifiable aspects of physician networks and referral patterns that contribute to observed disparities in DLE wound care. Results will inform how policy regarding physician network adequacy, health system organization, and payer incentives can improve quality of care for patients with DLE wounds and reduce disparities in healthcare utilization. The project team consists of multiple NIH funded researchers with ample expertise in health disparities research, network analysis of claims data, statistical methods, and knowledge of clinical context.

摘要/摘要糖尿病下肢 (DLE) 伤口影响高达 34% 的成人糖尿病患者，并且与大量的临床发病率/死亡率、医疗保健利用率的提高以及护理成本的提高。然而， DLE 伤口中持续存在的种族/民族和社会经济差异仍未得到很好的解决，而且很少了解医生服务的利用以及医生网络在观察到的差异中的作用。这提案回应 PAR-20-310，关于少数民族健康和健康差异的卫生服务研究，对医疗保健利用方面的种族/族裔和社会经济差异进行全国评估患有 DLE 伤口的患者，并评估医生网络和转诊模式在观察到的差异。通过兰德 AHRQ U19 卫生系统绩效卓越中心，我们的研究将利用多个医疗保险数据源、独特的医生级初步数据以及创新的改进种族/族裔受益人分类的方法。该研究将重点关注医疗保险按服务收费年龄在 65 岁及以上、有新的 DLE 伤口的受益人，并跟踪医疗保健的纵向利用在初次伤口诊断后的 6 个月内，跨多个临床环境提供服务。在目标 1 中，我们将使用多元回归技术来评估种族/民族和社会经济差异初次 DLE 伤口诊断后的医疗保健利用。然后，我们将绘制和描述医生网络和 DLE 伤口的转诊模式，并检查网络/转诊模式特征对医疗保健利用差异（目标 2）。最后，在目标 3 中，我们将模拟网络/推荐模式的变化特征并确定哪些特征具有更强的差距缩小效果，因此，适合干预发展。拟议的研究将确定潜在的可修改方面医生网络和转诊模式导致 DLE 伤口护理中观察到的差异。结果将告知有关医生网络充足性、卫生系统组织和付款人激励措施的政策可以提高 DLE 伤口患者的护理质量并减少医疗保健利用的差异。这项目团队由多名 NIH 资助的研究人员组成，他们在健康差异研究方面拥有丰富的专业知识，索赔数据、统计方法和临床背景知识的网络分析。