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

项目总结/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，在这方面， 一些患者群体接受的护理质量存在很大的差异。有人认为，结构 在医疗保健系统内和出院后社区设置的障碍转化为种族-民族 失语症和吞咽困难等疾病的结局差异。到目前为止，研究还没有检查 结构性障碍在结果差异中发挥作用。在这项研究中，我们提出测试的假设， 中风后治疗条件的各个阶段的结构障碍，如失语症， 吞咽困难导致康复护理质量的差异，随后导致种族-种族差异 失语症和吞咽困难这项研究的目的是研究医疗机构和 医疗保健提供者的做法影响到接受高质量的康复护理，以及它是否转化为种族歧视。 中风后结果的差异。本项目的目标将在完成 以下具体目标：目标1：确定卒中后急性 住院治疗对失语症和吞咽困难患者预后有不同影响。我们 假设嵌入在中风幸存者生活的医疗机构和社区中的过程将 规定：a）获得特定类型的护理，B）护理进展的路径，以及c）护理的强度。目标二： 确定护理的时机和过渡如何对患有以下疾病的个人的不同结果做出贡献： 失语症和吞咽困难。我们假设，嵌入在医疗保健设置的过程将导致变化 在失语症和吞咽困难的中风幸存者的急性到急性后护理的时机和过渡中， 在不同的设施/护理系统之间移动。目标3：确定出院后社区如何 环境导致失语症和吞咽困难个体的不同结果。我们 假设个人，社会和社区的繁荣和劣势的措施将有助于 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 医疗保险索赔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.