Implications of hospital-physician integration for urban-rural equity in access, care coordination, and outcomes.

项目摘要 博士布雷迪波斯特的长期目标是解释系统级集成如何影响质量和公平，具体来说， 对于农村居民来说。美国的医疗保健系统已经迅速走向更大的整合， 医院和医生。作为组织医疗保健服务的一种方式，医院-医生整合 在卫生政策界引起了很大争议。倡导者希望更多的效率和照顾 而怀疑论者则对成本和质量表示担忧。这一紧迫的政策问题，将成为一个 在未来几十年的医疗保健定义问题，需要专门的学者。布雷迪·波斯特医生把他的 他在密歇根大学攻读博士学位以来，一直致力于这一主题的研究，并继续建立 作为东北大学的一名助理教授。他职业生涯的下一步自然是 使用一套更复杂的方法来推进医院-医生整合的科学 这些方法将完善他的技能，同时有助于填补文献中持续存在的空白。 通过一个全面的培训计划，包括正式的课程和辅导，基于项目的学习， 该项目将使波斯特博士具备（1）对农村卫生需求、政策和服务提供的深入了解（2） 定性和混合方法技术;（3）调查设计和测量理论 research.这种独特的组合将使Post博士能够指导医院医生如何进行创新研究。 一体化改造了农村社区的保健。这项培训将建立他的技能，作为一个独立的 研究员，并准备他成功地竞争R 01级赠款。这个项目将研究 医院-医生在护理协调、患者获得护理和健康差异方面的整合 在农村和城市地区取得的成果。它将利用丰富的调查数据来突出患者的观点， 使用深入访谈来突出医生和管理者的观点。有了这个奖项，波斯特博士将带来 新的概念和新的方法，以文献上的医院医生整合的时候， 医疗保险和医疗补助服务中心、联邦贸易委员会和其他政策制定者正在 积极权衡增加集成的好处和缺点。这一建议直接回答了AHRQ的 要求开展卫生服务研究，以促进卫生公平（NOT-HS-21-014），重点关注AHRQ 农村居民优先。该奖项将支持博士邮政的过渡到独立，建立 他作为一个领先的学者对日益一体化的医疗保健系统的质量和公平的影响。

PROJECT SUMMARY Dr. Brady Post’s long-term goal is to explain how system-level integration affects quality and equity, specifically for rural residents. The American health care system has moved quickly toward greater integration between hospitals and physicians. As a way to organize healthcare services, hospital-physician integration has generated much controversy within the health policy community. Advocates hope for more efficiency and care coordination while skeptics raise concerns over costs and quality. This pressing policy issue, poised to be a defining issue in health care for decades to come, requires dedicated scholars. Dr. Brady Post has focused his scholarship on this topic since his doctoral studies at the University of Michigan and he continues to build the evidence base as an Assistant Professor at Northeastern University. A natural next step in his career is to advance the science on hospital-physician integration using a more sophisticated set of methodological approaches that will round out his skillset and, simultaneously, help to fill persistent gaps in the literature. Through a comprehensive training plan that includes formal coursework and mentored, project-based learning, this project will equip Dr. Post with (1) deep knowledge of rural health needs, policy, and service delivery (2) qualitative and mixed-methods techniques, and (3) survey design and measurement theory needed for survey research. This unique combination will position Dr. Post to direct innovative studies of how hospital-physician integration reshapes health care in rural communities. This training will build his skills as an independent researcher and prepare him to successfully compete for R01-level grants. This project will examine the effects of hospital-physician integration on care coordination, patient access to care, and disparities in health outcomes across rural and urban areas. It will leverage rich survey data to highlight patients’ perspectives and use in-depth interviews to highlight physicians’ and mangers’ perspectives. With this award, Dr. Post will bring new concepts and new approaches to the literature on hospital-physician integration at a time when the Centers for Medicare and Medicaid Services, the Federal Trade Commission, and other policymakers are actively weighing the benefits and drawbacks of increased integration. This proposal directly answers AHRQ’s request for health services research to advance health equity (NOT-HS-21-014) and focuses on the AHRQ priority population of rural residents. This award will support Dr. Post’s transition to independence, establishing him as a leading scholar on the quality and equity implications of increasingly integrated health care systems.