Use of Health Services by Caregivers in an Older biracial Population Sample

老年混血人口样本中护理人员使用健康服务的情况

• 批准号: 7578763
• 负责人: LIESI E HEBERT
• 金额: $ 40.84万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-04 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7578763
• 关键词: Accident and Emergency department; Address; Adult; Advertisements; Age; Aging; Ambulatory Care; American; Caregivers; Caring; Cessation of life; Characteristics; Clinical; Communities; Continuity of Patient Care; Data; Data Set; Disease; Emotional; Excess Mortality; Health; Health Services; Healthcare Systems; Hospitalization; Individual; Intervention; Interview; Knowledge; Life Cycle Stages; Medicaid; Medical; Medicare; Medicare claim; Morbidity - disease rate; Not Hispanic or Latino; Nursing Homes; Pathway interactions; Patient Self-Report; Pattern; Physicians; Population; Preventive; Quality of life; Reporting; Research; Resources; Risk; Risk Factors; Sampling; Self Care; Services; Severities; Societies; Source; Staging; Support Groups; Surveys; Testing; Translating; Visit; Work; aging population; billing data; caregiving; comparison group; cost; disability; economic value; emotional experience; follow-up; health care service utilization; high risk; improved; interest; knowledge base; mortality; neglect; population based; pre-clinical; public health relevance; routine care; volunteer

DESCRIPTION (provided by applicant): Informal caregivers are a vital part of the health care system and their importance will grow with the aging of the U.S. population. Research has found a significantly higher risk of death among older caregivers who reported emotional strain due to caregiving. However, the pathway to this increased mortality risk is not clear. Studies have shown an association between caregiving and preclinical and clinical disease, but there is a large gap in scientific knowledge about the effect of caregiving on morbidity and mortality. Our general hypothesis is that both self-care and formal care is compromised among caregivers, especially those experiencing emotional strain, resulting in poorer medical management, less continuity of care, and greater progression of the caregiver's treatable conditions, as shown by patterns of health service use. Currently available evidence concerning this hypothesis is limited and results are contradictory. Most studies: 1) treated caregiving as a static construct, rather than a life- cycle construct (with before, during and after caregiving stages), 2) used clinical or volunteer samples which may not be representative of all caregivers and 3) which have difficulty identifying reliably comparable non-caregivers, and 4) identified health care service retrospectively by self-report which limits precision and detail of information. We propose to examine the effect of caregiving on health by investigating differences in health care service use across the caregiving life cycle in a biracial population-based sample of 599 people age 65 or older. To uniformly assess health service utilization, we will use Medicare billing data over the specific interval during which caregiving stage and other relevant characteristics were identified. Because data are already available from a longitudinal, population-based study of caregivers, the hypotheses can be tested at small cost. We hypothesize that during caregiving, people will have fewer preventive and routine physician visits, less continuity of care, and physician visits with higher intensity of care than non-caregivers or former caregivers. During and after caregiving people will have more emergency department (ED) visits, more urgent and emergent ED visits, more hospitalizations, and more hospitalizations for ambulatory care sensitive conditions (ACSC) than non-caregivers. We further hypothesize that these relationships will be similar for non-Hispanic blacks and whites and that among caregivers, service use will be modified by level of emotional strain. PUBLIC HEALTH RELEVANCE: If results of this work suggest caregivers neglect their own health it could point to ways of reducing the excess mortality associated with caregiving. Most interventions focus on the needs of the care recipient; this work may suggest ways caregivers should be assisted to care for their own health.

描述（由申请人提供）：非正式护理人员是医疗保健系统的重要组成部分，他们的重要性将随着美国人口的老龄化而增长。研究发现，在那些因照顾而情绪紧张的老年照顾者中，死亡风险明显更高。然而，这种死亡风险增加的途径尚不清楚。研究表明，护理与临床前和临床疾病之间存在关联，但关于护理对发病率和死亡率的影响的科学知识存在很大差距。我们的一般假设是，自我护理和正式护理在照顾者中都受到损害，特别是那些经历情绪紧张的人，导致较差的医疗管理，较低的护理连续性，以及照顾者可治疗状况的更大进展，如卫生服务使用模式所示。目前有关这一假设的证据有限，结果相互矛盾。大多数研究：1)将护理作为一个静态结构，而不是一个生命周期结构（包括护理前、护理中和护理后阶段）；2)使用临床或志愿者样本，可能不能代表所有护理者；3)难以可靠地识别可比较的非护理者；4)通过自我报告回顾性地识别医疗保健服务，这限制了信息的准确性和细节。我们建议通过调查599名年龄在65岁或以上的混血儿人群样本在护理生命周期中卫生保健服务使用的差异来检验护理对健康的影响。为了统一评估医疗服务的利用率，我们将使用医疗保险计费数据，在此期间，护理阶段和其他相关特征被确定。由于一项针对护理人员的纵向、基于人群的研究已经提供了数据，因此可以以很小的成本对这些假设进行测试。我们假设，在护理期间，人们会有更少的预防性和常规医生就诊，更少的连续性护理，以及更高强度的医生就诊，而不是非护理者或前护理者。在护理期间和之后，人们将比非护理者有更多的急诊（ED）访问，更多的紧急和紧急ED访问，更多的住院治疗和更多的门诊护理敏感条件（ACSC）住院治疗。我们进一步假设，这些关系在非西班牙裔黑人和白人中是相似的，在照顾者中，服务的使用将受到情绪紧张水平的影响。公共卫生相关性：如果这项工作的结果表明照顾者忽视了自己的健康，它可以指出减少与照顾相关的超额死亡率的方法。大多数干预措施侧重于受照护者的需要；这项工作可能会提出帮助护理人员照顾自己健康的方法。