Disparities in Post-Acute Rehabilitation Care

急性后康复护理的差异

• 批准号: 7616084
• 负责人: JANET Kues FREBURGER
• 金额: $ 14.54万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-01 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7616084
• 关键词: Acute; Address; Affect; Age; American; American Hospital Association; Area; Attitude; Behavioral Model; Belief; Caregivers; Caring; Censuses; Cessation of life; Characteristics; Communities; Data; Data Analyses; Databases; Diagnosis; Elderly woman; Ethnic Origin; Exploratory/Developmental Grant; Foundations; Future; Gender; Health; Health Care Costs; Health Personnel; Healthcare; Healthcare Systems; Hip Fractures; Home environment; Hospitalization; Hospitals; Improve Access; Income; Individual; Inpatients; Institution; Institutionalization; Insurance Coverage; Intermediate Care Facilities; Intervention; Long-Term Care; Low income; Marital Status; Medicare; Minority; Nursing Homes; Older Population; Outcome; Outpatients; Patients; Play; Population; Prospective Payment System; Quality of life; Race; Regression Analysis; Rehabilitation therapy; Replacement Arthroplasty; Reporting; Research; Resources; Role; Rural; Series; Severity of illness; Sex Characteristics; Skilled Nursing Facilities; Socioeconomic Status; Stroke; Subgroup; Surveys; Techniques; Testing; Underserved Population; United States Agency for Healthcare Research and Quality; Work; base; cohort; functional disability; health care quality; health disparity; improved; income insurance; population based; public health relevance; racial difference; socioeconomics; therapy development

DESCRIPTION (provided by applicant): The broad long-term objective of this research is to inform the development of interventions that will improve access to, use of, and quality of post-acute rehabilitation care for underserved populations. The primary objective of the proposed study is to gain a more thorough and current understanding of disparities in the use of post-acute rehabilitation care following hip fracture, joint replacement, and stroke. This study proposes to pool and analyze state-specific hospital discharge data from four geographically and demographically diverse states (AZ, FL, NJ, WI). The hospital discharge data will be merged with data from the American Hospital Association Annual Survey database, the Area Resource File, and U.S. Census data. Descriptive, bivariate, and multivariable regression analyses for discrete outcomes, including multi-level analyses, will be conducted for each condition to achieve the following specific aims: 1) Describe the sociodemographic (race, ethnicity, age, gender, socioeconomic status) and geographic disparities (urban/rural, state) in the use of post-acute rehabilitation care. Through descriptive and bivariate analyses of the data, we will determine the extent to which use of post-acute rehabilitation care varies by each sociodemographic and geographic characteristic. 2) Determine the extent to which identified sociodemographic and geographic disparities are explained by other observed characteristics. Through a series of multivariable analyses examining individual and community-level characteristics associated with the use of post-acute rehabilitation care and through the use of decomposition techniques we will determine the extent to which the identified disparities are explained by other observed characteristics. More specifically, we will determine the extent to which the identified disparities are: a. confounded by other observed characteristics (e.g., insurance status and/or disease severity may explain some of the racial differences in use; marital status may explain some of the gender differences in use); b. moderated by other observed characteristics (e.g., disparities in use may differ for low income and high income minorities); c. explained by individual versus community-level characteristics (we hypothesize that both individual and community-level factors will explain differences in use); and d. unexplained by the characteristics examined in this study (we hypothesize that some of the identified differences in use will be unexplained). PUBLIC HEALTH RELEVANCE: Post-acute rehabilitation care is an effective and growing area of health care that has not been adequately investigated in regard to health care disparities. Identifying the extent to which disparities exist in post-acute rehabilitation care and determining underlying reasons for these disparities are necessary first steps in developing interventions to eliminate these disparities.

描述（由申请人提供）：本研究的广泛长期目标是为制定干预措施提供信息，这些干预措施将改善服务不足人群的急性期后康复护理的获得、使用和质量。本研究的主要目的是对髋部骨折、关节置换术和卒中后急性期后康复治疗的差异有一个更全面的了解。本研究建议汇总和分析来自四个地理和人口统计学上不同的州（AZ，FL，NJ，WI）的特定州的出院数据。出院数据将与美国医院协会年度调查数据库、地区资源文件和美国人口普查数据合并。将对每种疾病进行离散结局的描述性、双变量和多变量回归分析，包括多水平分析，以实现以下特定目标： 1)描述在使用急性期后康复护理方面的社会人口统计学（种族、民族、年龄、性别、社会经济地位）和地理差异（城市/农村、州）。通过对数据的描述性和双变量分析，我们将确定急性期后康复护理的使用因每个社会人口统计学和地理特征而异的程度。 2)确定已确定的社会人口和地理差异在多大程度上可以通过其他观察到的特征来解释。通过一系列的多变量分析，检查与使用急性期后康复护理相关的个人和社区层面的特征，并通过使用分解技术，我们将确定在何种程度上所确定的差异被其他观察到的特征解释。更具体地说，我们将确定所识别的差异的程度：a.被其它观察到的特征混淆（例如，保险状况和/或疾病严重程度可以解释使用中的一些种族差异;婚姻状况可以解释使用中的一些性别差异）; B.由其它观察到的特征（例如，低收入和高收入少数群体的使用差异可能不同; c.由个人与社区层面的特征来解释（我们假设个人和社区层面的因素都可以解释使用的差异）; d.本研究中检查的特征无法解释（我们假设使用中的一些识别差异无法解释）。公共卫生相关性：急性期后康复护理是一个有效的和不断增长的卫生保健领域，尚未充分调查卫生保健方面的差距。确定在何种程度上存在的差距在急性期后康复护理和确定这些差距的根本原因是必要的第一步，在制定干预措施，以消除这些差距。

项目成果

Postacute rehabilitation care for hip fracture: who gets the most care?

• DOI: 10.1111/j.1532-5415.2012.04149.x
• 发表时间: 2012-10
• 期刊: Journal of the American Geriatrics Society
• 影响因子: 6.3
• 作者: Freburger JK;Holmes GM;Ku LJ
• 通讯作者: Ku LJ

Disparities in post-acute rehabilitation care for joint replacement.

• DOI: 10.1002/acr.20477
• 发表时间: 2011-07
• 期刊: ARTHRITIS CARE & RESEARCH
• 影响因子: 4.7
• 作者: Freburger, Janet K.;Holmes, George M.;Ku, Li-Jung E.;Cutchin, Malcolm P.;Heatwole-Shank, Kendra;Edwards, Lloyd J.
• 通讯作者: Edwards, Lloyd J.