Structural Racism and Discrimination in the Expansion of Hospital Stroke Care Capacity: A Multi-Level Analysis on Access to Care, Treatment, and Outcomes

扩大医院中风护理能力中的结构性种族主义和歧视：对获得护理、治疗和结果的多层次分析

• 批准号: 10473300
• 负责人: Renee Yuen-Jan Hsia
• 金额: $ 56.27万
• 依托单位: NATIONAL BUREAU OF ECONOMIC RESEARCH
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-14 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10473300
• 关键词: Acute; Address; Admission activity; Adopted; Adoption; Area; Black race; Caring; Censuses; Certification; Cessation of life; Code; Communities; Community Health; Community Hospitals; Community Outreach; Data; Databases; Dimensions; Disadvantaged; Discrimination; Disease; Ensure; Ethnic Origin; Face; Geography; Goals; Guidelines; Health; Health Services Accessibility; Healthcare Systems; Hispanic; Home; Hospitals; Income; Individual; Inequality; Intervention; Intravenous; Left; Life Cycle Stages; Low income; Measures; Medicare; Medicare claim; Mission; Modeling; Morbidity - disease rate; National Institute on Minority Health and Health Disparities; Outcome; Pathway interactions; Patients; Pattern; Population; Probability; Public Health; Race; Research; Resources; Role; Rural Population; Services; Stroke; Structural Racism; Structure; Survival Analysis; System; Technology; Testing; Thrombectomy; Thrombolytic Therapy; Time; Treatment outcome; United States; United States National Institutes of Health; acute care; acute stroke; aging population; design; disability; disadvantaged population; disparity reduction; endovascular thrombectomy; ethnic minority; experience; functional outcomes; health disparity; health disparity populations; hospital readmission; improved; mortality; multilevel analysis; population health; racial and ethnic; racial and ethnic disparities; racism; rural area; rural health disparities; rural patients; segregation; social health determinants; socioeconomics; stroke patient; stroke therapy; telehealth; telestroke; treatment disparity; urban area

OTHER PROJECT INFORMATION – Project Summary/Abstract Structural Racism and Discrimination in the Expansion of Hospital Stroke Care Capacity Although advances in the treatment of stroke have significantly decreased morbidity and mortality for stroke patients in the United States, there is a growing disparity in the provision of stroke services between disadvantaged populations and others. No studies have examined the role of structural racism and discrimination (SRD) in the expansion of stroke care capacity across communities and subsequent effects on health disparity patients. The long-term goal of this project is to identify system-level pathways in the delivery of acute stroke care that contribute to the growing disparities for NIH-designated health disparity populations (defined as racial/ethnic minority, low-income, and rural patients). The overall objective is to determine the mechanisms through which health disparity patients experience SRD in stroke care. Using national data from 2009 to 2019, we propose three aims to test the following hypotheses: Aim 1, That disadvantaged communities (defined as segregated areas with high shares of health disparity populations) experience differential adoption of levels of stroke care, resulting in increased disparities in potential access to care relative to other communities. Aim 2, That health disparity patients in segregated communities experience increased disparities in actual access and treatment due to patient redistribution across hospitals with different levels of stroke care and differential treatment within hospitals. Aim 3, That individuals in disadvantaged communities and health disparity patients experience widening disparities in health and functional outcomes. In Aim 1, we will identify which types of disadvantaged communities, if any, were left behind in gaining stroke care access, and whether racial or ethnic segregation and income inequality contribute to these structural disparities in geographic access. These results will aid certification bodies to consider incorporating community need in certification guidelines. In Aim 2, our results will illuminate patient redistribution patterns in communities that gain access to stroke care and pinpoint patients who experience disparities in actual access and treatment depending on their race, ethnicity, and income as well as the level of segregation in each of those dimensions. Results will identify the types of communities where outreach might be most effective in reducing disparities in stroke care. In Aim 3, our results will determine the extent of health disparities among stroke patients a) between disadvantaged and non-disadvantaged communities after adoption of stroke care, compared to communities with no change; and b) between health disparity and other patients within the same community when those communities experience changes in stroke care, relative to those in communities with no change in access to stroke care. These findings will identify specific communities where additional interventions (e.g., mobile stroke units, enhancing telehealth access) could yield the greatest benefits.

其他项目信息-项目概要/摘要 扩大医院中风护理能力中的结构性种族主义和歧视 虽然中风治疗的进步已经显著降低了中风的发病率和死亡率， 在美国，中风患者之间提供中风服务的差距越来越大， 弱势群体和其他人。没有任何研究审查结构性种族主义的作用， 歧视（SRD）在扩大中风护理能力的社区和随后的影响， 健康不平等患者该项目的长期目标是确定交付过程中的系统级路径 急性卒中护理导致NIH指定的健康差异人群的差异日益扩大 （定义为种族/少数民族、低收入和农村患者）。总体目标是确定 脑卒中护理中健康差异患者经历SRD的机制。 利用2009年至2019年的国家数据，我们提出了三个目标来检验以下假设：目标1， 弱势社区（被定义为健康差距很大的隔离地区） 人群）经历不同程度的卒中护理，导致 相对于其他社区而言，获得护理的可能性。目的2，将健康差异患者隔离 由于病人的重新分布，社区在实际获得和治疗方面的差距越来越大 在不同级别的中风护理和医院内的差异治疗的医院之间。目标3，这 弱势群体中的个人和健康差距患者在以下方面的差距不断扩大： 健康和功能结果。 在目标1中，我们将确定哪些类型的弱势群体（如果有的话）在获得 中风护理的获得，以及种族或民族隔离和收入不平等是否会导致这些情况 地理上的结构性差异。这些结果将有助于认证机构考虑纳入 社区需要认证指南。在目标2中，我们的结果将阐明患者的再分布模式， 获得中风护理的社区，并查明在实际获得方面存在差异的患者 和待遇取决于他们的种族，民族和收入，以及隔离的程度，在每一个 这些尺寸。研究结果将确定在哪些社区开展外联活动可能最有效， 减少中风护理的差异。在目标3中，我们的研究结果将确定 中风患者a）在接受中风护理后处于不利地位的社区和非不利地位的社区之间， 与没有变化的社区相比;以及B）健康差异与同一社区内的其他患者之间 当这些社区经历中风护理的变化时，相对于那些 中风护理的可及性没有变化。这些发现将确定特定社区， 干预（例如，移动的卒中单元，增强远程医疗服务）可以产生最大的效益。