权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Understanding and Addressing Disparities in Primary Care: A National Mixed Methods Study

了解和解决初级保健方面的差异：一项全国混合方法研究

基本信息

批准号：
10777104
负责人：
ELLIOTT S FISHER
金额：
$ 82.95万
依托单位：
DARTMOUTH COLLEGE
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：
2023-09-30 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10777104
关键词：
Academy Address Adoption Age Alzheimer&apos s disease related dementia COVID-19 COVID-19 pandemic Caring Case Study Cessation of life Chronic Chronic Disease Communities County Cross-Sectional Studies Data Data Set Diagnosis Disease Progression Disparity Economics Elderly Ensure Fee-for-Service Plans Foundations Funding Goals Health Health Services Accessibility Health system Healthcare Healthcare Systems Hospitalization Incidence Inequity Intervention Interview Investigation Life Expectancy Link Low income Measures Medicaid Medicare Medicare claim Medicine Methods Minority Minority Groups Names Neighborhood Health Center Outcome Ownership Physicians Play Policies Policy Maker Population Prevention Primary Care Primary Care Physician Process Qualitative Research Quality of Care Recommendation Reduce health disparities Reporting Research Project Grants Resources Respondent Risk Role Rural Sampling Site Surveys System Testing Travel United States United States Agency for Healthcare Research and Quality United States National Institutes of Health Update Wood material Work beneficiary care outcomes cohort contextual factors data resource disability disparity reduction evidence base falls health determinants health disparity improve minority health improved informant insight minority health disparity modifiable risk mortality practice factors premature prevent primary care practice primary care provider residential segregation rural residence safety net social trend

项目摘要

ABSTRACT Disparities in health within the U.S. are pervasive and, for some populations, widening. High-quality primary care plays an important role in the prevention, diagnosis and management of the many chronic health conditions that contribute to health disparities among older adults. Primary care in the U.S., however, is threatened. Even before COVID-19, the per-capita supply of primary care physicians was falling and varied dramatically by county, threatening rural and other less-advantaged communities. Little is known about how access to high-quality primary care has changed in recent years—including changes in access associated with the COVID-19 pandemic—or about the policy-, system-, or practice-level factors that are associated with better quality of primary care for older adults. These gaps in understanding have hindered our ability, as a nation, to provide the best care to older adults. This project will address this need by drawing on a unique national dataset that includes annual information on the ownership and staffing of all U.S. primary care practices from 2015–2024, linked Medicare claims data, and surveys of nationally representative samples of these practices conducted in 2017 and 2022. Work in this project will entail: Aim 1: Examine U.S. trends in access to primary care for Medicare beneficiaries in traditional Fee-for-Service and Medicare Advantage and determine how these trends varied for less-advantaged populations. The team will conduct repeated cross-sectional studies of access to primary and relevant subspecialty care for Medicare enrollees and how trends in access to care varied for less-advantaged populations. Aim 2: Identify the policy-, system-, and practice-level factors associated with better processes and outcomes of care for Medicare beneficiaries, with a focus on those with fewer social and economic advantages. The team will take advantage of the substantial differences across states, delivery systems, and physician practices in the implementation of initiatives intended to improve and support primary care to apply differences-in-differences approaches to identify potentially high impact factors. Aim 3: Conduct qualitative research to deepen our understanding of the underlying barriers and facilitators to improving primary care for less advantaged populations. Under this aim, the team will conduct key informant interviews with experts on policy, primary care and the safety net to deepen our understanding of current challenges and opportunities facing safety net practices. The team will then purposively sample practices that participated in the 2022 survey that serve economically less-advantaged and minoritized populations and conduct in-depth qualitative interviews with their leaders and staff. Findings across these three aims will be triangulated to develop recommendations that can assist practice leaders, health system leaders, and policymakers in improving primary care and reducing health disparities for older adults.

摘要美国国内的健康差距无处不在，对一些人来说，差距还在扩大。高质量的初级护理在许多慢性健康的预防、诊断和管理中发挥着重要作用造成老年人健康差距的条件。然而，在美国，初级保健是受到威胁。即使在新冠肺炎之前，初级保健医生的人均供应量就在下降，而且五花八门每个县都在戏剧性地增加，威胁到农村和其他不太有利的社区。人们对此知之甚少近年来，获得高质量初级保健的机会发生了变化，包括与以下方面相关的获得机会的变化新冠肺炎大流行--或关于政策、制度或实践层面的因素老年人初级保健的质量。这些理解上的差距阻碍了我们作为一个国家的能力为老年人提供最好的护理。该项目将通过利用一个独特的国家数据集，包括所有美国初级保健实践的所有权和人员配备的年度信息 2015-2024年，关联的联邦医疗保险索赔数据，以及对这些做法的全国代表性样本的调查分别于2017年和2022年进行。该项目的工作将包括：目标1：审查美国在初级卫生保健方面的趋势在传统的按服务收费和联邦医疗保险优势中照顾联邦医疗保险受益人并确定如何这些趋势对于不那么有利的人群来说是不同的。该团队将进行反复的横断面研究医疗保险参保人获得初级和相关专科医疗服务的机会以及获得医疗服务的趋势对于不那么有利的人群，情况各不相同。目标2：确定政策、制度和实践层面的因素与更好的医疗保险受益人护理过程和结果相关，重点是那些患有较少的社会和经济优势。该团队将利用各国之间的重大差异国家、交付系统和医生在实施旨在改善和支持初级保健应用差异方法，以确定潜在的高影响因素。目标3：进行定性研究，加深我们对潜在障碍和促进者的理解改善对弱势群体的初级保健。在这一目标下，该团队将进行关键线人与政策、初级保健和安全网方面的专家进行访谈，加深我们对当前安全网实践面临的挑战和机遇。然后，团队将有目的地对实践进行抽样，参与了2022年的调查，这些调查服务于经济条件较差和属于少数群体的人群，并对他们的领导和员工进行深入的定性访谈。这三个目标的调查结果将是三角化以制定建议，以帮助实践领导者、卫生系统领导者和政策制定者在改善初级保健和减少老年人的健康差距方面发挥了重要作用。