Exploring Pathways to Equitable Outcomes in Post-Stroke Aphasia and Dysphagia

项目摘要/摘要 有证据表明，在过去的25年里，美国的医疗质量有了很大的提高。然而， 一些患者群体接受的护理质量存在很大差异。一些人认为，结构性的 医疗保健系统内部和出院后社区环境中的障碍转化为种族-民族 失语症和吞咽困难等疾病的结局存在差异。到目前为止，研究还没有检查过 结构性障碍在结果差异中发挥作用。在这项研究中，我们建议检验以下假设 卒中后治疗条件不同阶段的结构性障碍，如失语症和 吞咽困难导致康复护理质量的差异，并随后导致种族-民族差异 在失语和吞咽困难的结局中。这项研究的目标是检查医疗机构和 医疗保健提供者的做法影响高质量康复护理的接受，以及它是否会转化为种族 中风后预后的差异。这一项目的目标将通过完成 以下具体目标：目标1：确定卒中后急症的可获得性、可及性和质量 住院治疗会导致失语症和吞咽困难患者的不同结果。我们 假设中风幸存者生活的医疗保健环境和社区中嵌入的过程将 规定：a)获得特定类型的护理，b)护理进展的路径，以及c)护理强度。目标2： 确定护理的时间安排和过渡如何影响患者的不同结果 失语症和吞咽困难。我们假设，嵌入到医疗保健环境中的流程将导致变化 在卒中幸存者失语和吞咽困难的时机和从急性到后急性护理的过渡中 在不同的护理设施/系统之间移动。目标3：确定出院后社区如何 环境会导致失语症和吞咽困难患者的不同结果。我们 假设个人、社会和社区对繁荣和不利的衡量标准将有助于 失语症和吞咽困难患者预后的种族差异。为了完成这项研究，我们将使用 Medicare声称的数据将使我们能够跟踪患有失语症和吞咽困难的中风幸存者的护理 在整个护理过程中。

PROJECT SUMMARY/ABSTRACT Evidence suggests quality of care has substantially improved in the in the US has over last 25 years. However, wide variability exists in the quality of care that some patient groups receive. Some suggest that structural barriers in within healthcare systems and in post-discharge community settings translate into racial-ethnic disparities in outcomes for conditions such as aphasia and dysphagia. To date, studies have not examined the role structural barriers play role in disparities in outcomes. In this study we propose to test the hypothesis that structural barriers at various stages of the post-stroke treatment condition for conditions like aphasia and dysphagia contribute to differences in quality of rehabilitation care and subsequently to racial-ethnic differences in aphasia and dysphagia outcomes. The objective of this study is to examine how healthcare institutions and healthcare provider practices impacts the receipt of quality rehabilitative care and whether it translates into racial disparities in post-stroke outcomes. The objective of this project will be achieved by the completion of the following specific aims: Aim 1: Determine how availability, accessibility, and quality of post-stroke acute inpatient care contribute to disparate outcomes of individuals with aphasia and dysphagia. We hypothesize that processes embedded in healthcare settings and communities where stroke survivors live will dictate: a) access to specific types of care, b) the path of care progression, and c) intensity of care. Aim 2: Determine how the timing and transition of care contribute to disparate outcomes of individuals with aphasia and dysphagia. We hypothesize that processes embedded in healthcare settings will lead to variations in the timing and transition from acute to post-acute care of stroke survivors with aphasia and dysphagia as they move across different facilities/systems of care. Aim 3: Determine how the post-discharge community environments contribute to disparate outcomes of individuals with aphasia and dysphagia. We hypothesize that personal, social, and community measures of prosperity and disadvantage will contribute to racial disparities in outcomes among individuals with aphasia and dysphagia. To complete this study we will use Medicare claims data which will enable us to track the care of stroke survivors with aphasia and dysphagia across the entire continuum of care.