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Racial Differences in Hospital-Associated Disability and Acute and Post-Acute Care Physical Therapy Utilization

医院相关残疾以及急性和急性后护理物理治疗利用的种族差异

基本信息

批准号：
10785500
负责人：
Maylyn Martinez
金额：
$ 13.45万
依托单位：
UNIVERSITY OF CHICAGO
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：
2023-09-24 至 2028-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10785500
关键词：
Academic Medical Centers Activities of Daily Living Acute Address Admission activity Affect Age Area Black race Caring Cessation of life Chicago Clinical Data Communities Complex Data Decision Making Dementia Development Development Plans Disadvantaged Disparity Documentation Face Funding Future Goals Health Care Costs Health Disparities Research Health care facility Healthcare Healthcare Systems Hospitalization Hospitals Hylobates Genus Impairment Individual Inpatients Institutionalization Intervention K-Series Research Career Programs Knowledge Lead Length of Stay Logistic Regressions Measures Medical Medical Care Team Medical center Mentors Mentorship Modeling National Institute on Minority Health and Health Disparities Outcome Patient Discharge Patients Peripheral arterial disease Physical Function Physical Rehabilitation Physical therapy Population Heterogeneity Prevention Protocols documentation Qualitative Methods Race Recommendation Rehabilitation therapy Research Research Methodology Research Personnel Resources Risk Role Sampling Site Statistical Models Testing Training Trauma Underserved Population United States National Institutes of Health Variant Woman Work acute care age stratification black patient black women care systems career career development clinical data warehouse comorbidity deconditioning deprivation design disability disability risk experience functional decline functional disability functional improvement functional outcomes health care disparity health disparity high risk hospital readmission human old age (65+)implementation science improved indexing member patient population phenomenological models predictive tools prevent racial determinant racial difference racial disparity racism readmission risk risk prediction sex skills social determinants social vulnerability socioeconomics

项目摘要

PROJECT SUMMARY Hospital-associated disability (HAD), defined as the new loss of ability to complete one or more activities of daily living without assistance at hospital discharge, occurs in nearly one-third of all hospitalized patients. HAD and low mobility during hospitalization are associated with readmissions, permanent disability, new institutionalization, death and escalating healthcare costs. While access to physical therapy (PT) is critical for functional improvement, my preliminary data from a single site suggests Black patients face disparities in both functional impairments and PT referrals. However, it is currently unclear whether this is true across sites, whether social vulnerability affects these outcomes, or why this occurs. Therefore, this proposal aims to characterize the association of Black race and social vulnerability with development of HAD and referral for acute and post-acute physical therapy across a set of Chicago area academic medical centers. I also aim to explore racial differences in perspectives on mobility loss and participation in PT. I hypothesize that Black race and social vulnerability are associated with HAD and physical rehabilitation use. I will test my hypothesis in three aims: Aim 1) I will assess differences, by race and Area Deprivation Index (ADI), a measure of social vulnerability, in HAD and inpatient physical therapy referrals in three academic medical centers across Chicago conferring a socioeconomically diverse patient sample; Aim 2) Across these medical centers, I will also determine differences by race and ADI, in rates of recommendation for discharge to post-acute care (PAC) facilties for PT and actual discharge to PAC facilities for PT when recommended; Aim 3) I will use qualitative methods to explore patients’ experiences with mobility loss and participation in PT during hospitalization; and interdisciplinary care team documentation for Black vs. White patients. My long-term goal is to develop a model to predict HAD risk and likelihood of benefit from skilled physical rehabilitation during hospitalization to reduce the burden of HAD on diverse populations of patients. To accomplish this, I have developed an exceptional interdisciplinary team of mentors (Drs. Meltzer, Arora, Lagu) and advisors (Drs. Peek, Chin, Jayaraman, Gibbons) who have a track record of NIH-funding and successful mentorship of early career investigators. I have formulated an in-depth career development plan to gain expertise in health disparities research (Chin, Peek, Meltzer), disability and physical rehabilitation in hospitalized patients, (Arora, Lagu, and Jayaraman), and incorporation of race and social determinants in statistical modeling to reduce bias (Gibbons, Peek, Chin). Completion of this proposal will train me to address each level of influence (individual, interpersonal, community, societal) within the “healthcare system” domain of influence outlined in the NIMHD’s research framework. Equipped with advanced skills and knowledge in health disparities research methodology and the role of race and racism in healthcare, I will be able to design unbiased risk prediction tools and physical rehabilitation protocols and lead their culturally-tailored implementation in diverse populations in future R01 level applications.

项目总结