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Disparities in Quality Healthcare Among Childhood Cancer Survivors: Role of Medicaid

儿童癌症幸存者的医疗质量差异：医疗补助的作用

基本信息

批准号：
10722895
负责人：
Xu Ji
金额：
$ 13.11万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-21 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10722895
关键词：
Address Adult Adverse effects Affect Affordable Care Act Age Automobile Driving Award COVID-19 pandemic Cancer Center Cancer Survivor Cancer Survivorship Caring Censuses Characteristics Childhood Childhood Cancer Survivor Study Chronic Chronic Disease Clinical Data Communities Cost Sharing Cross-Sectional Studies Data Detection Discrimination Disease Disparity Drops Early treatment Enrollment Ensure Equity Ethnic Origin Face Financial Hardship Foundations Future Goals Health Healthcare Impaired cognition Improve Access Individual Institution Insurance Insurance Coverage International Intervention Interview Knowledge Late Effects Lead Leadership Link Low income Malignant Childhood Neoplasm Malignant Neoplasms Measurable Measures Medicaid Mentorship Methods Modeling National Institute on Minority Health and Health Disparities Outcome Participant Patient Care Patients Pediatric Oncology Policies Population Qualitative Methods Quality of Care Quality of life Race Rare Diseases Recording of previous events Reduce health disparities Research Research Methodology Research Personnel Research Priority Role Scientist Services Societies Socioeconomic Status Source Structure Survey Methodology Surveys Survivors System Training Underserved Population United States Validation Work beneficiary cancer therapy care coordination care delivery care providers career childhood cancer survivor clinical care cohort design ethnic minority experience follow-up hands-on learning health care disparity health care quality health disparity health literacy high risk implementation science improved learning strategy low socioeconomic status medical specialties minority health multidisciplinary post-pandemic pre-pandemic programs public health insurance racial health disparity racial minority recruit rural disparities rural dwellers rurality satisfaction sex sex disparity skills sociodemographic group socioeconomics tool urban disparity voltage

项目摘要

PROJECT SUMMARY/ABSTRACT Survivors of childhood cancer require life-long healthcare to improve quality of life and health. However, the majority of adult survivors of childhood cancer, including those with public health insurance (primarily Medicaid), lack long-term healthcare. There are crucial gaps in our current understanding of disparities in patient care and the modifiable factors that create and perpetuate disparities in care among childhood cancer survivors in the Medicaid system. This study will use qualitative and survey research methods to systematically assess survivor experience of care in the Medicaid system and determine sources of disparities affecting care experience among adult survivors of childhood cancer. We anticipate contacting for potential recruitment a total of 2,700 adult survivors insured with Medicaid from the Childhood Cancer Survivor Study (CCSS), including: 20 survivors for qualitative survivor interviews (Aim 1), among whom 8 survivors will participate in a Delphi panel (Aim 2); 144 survivors for a pilot survey (Aim 2); and 2,536 survivors for an expanded survey (Aim 3). For Aim 1, we will also include 10 stakeholder participants (care providers and financial navigators) from CCSS participating institutions for qualitative stakeholder interviews. The specific aims are as follows. Aim 1: Use qualitative methods to explore multi-level barriers to quality healthcare for adult survivors of childhood cancer in the Medicaid system. Aim 2: Develop and validate a survey to quantify survivor experiences with the Medicaid system. Aim 3: Assess racial/ethnic, socioeconomic, rural-urban, and sex disparities in survivor experiences with insurance and healthcare in Medicaid, and how disparities are related to survivor-, community-, and state-level characteristics. The focus of this study aligns with the NIMHD’s research priority to understand and reduce health disparities by race/ethnicity, socioeconomic status, rurality, and sex. Data gained from this study will form the foundation for an R01 proposal to survey state-specific cancer survivor cohorts, with the goal of informing interventions that promote equitable, high-quality care based on state Medicaid program rules. The candidate’s long-term career goal is to become an independent scientist with a research program focused on addressing disparities in health and healthcare after childhood cancer. Under the mentorship of international experts in health disparities/minority health and cancer survivorship, the candidate will accomplish her short-term goals to 1) develop expertise in health disparities and implementation science, 2) acquire qualitative and survey research skills, 3) understand patient experience in pediatric oncology and cancer survivorship, and 4) improve research leadership and management skills to complete transition to independence. The integrated training plan includes a mix of didactic courses, hands-on learning activities, and focused multidisciplinary mentorship that will advance the candidate’s research skills and ensure her transition to a fully independent investigator.

项目总结/文摘