Addressing Disparities in Bariatric Surgery outcomes for Medicaid Patients

解决医疗补助患者减肥手术结果的差异

• 批准号: 9788526
• 负责人: Luke M Funk
• 金额: $ 22.95万
• 依托单位: UNIVERSITY OF WISCONSIN-MADISON
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-19 至 2021-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9788526
• 关键词: Academic Medical Centers; Address; Adult; Affect; Area; Bariatrics; Behavioral; Body Weight decreased; Body mass index; Cardiovascular Diseases; Caring; Cause of Death; Characteristics; Collection; Communities; Comorbidity; Computer software; Data; Data Analyses; Data Collection; Day Surgery; Development; Diabetes Mellitus; Economics; Education; Educational Status; Effectiveness of Interventions; Electronic Health Record; Emergency department visit; Employment Status; Etiology; Goals; Health; Health system; Income; Institution; Insurance Coverage; Intervention; Interview; Link; Logistic Regressions; Longevity; Low income; Medicaid; Medical; Medical Care Costs; Modeling; Morbid Obesity; Morbidity - disease rate; Obesity; Observational Study; Operative Surgical Procedures; Outcome; Patient Care; Patients; Physical environment; Policy Making; Population; Postoperative Period; Provider; Public Health; Quality of life; Randomized Controlled Trials; Reporting; Research; Research Design; Research Methodology; Research Personnel; Research Proposals; Resolution; Site; Socioeconomic Status; Structure; System; Time; United States; United States National Institutes of Health; Weight; Weight maintenance regimen; Wisconsin; Work; bariatric surgery; clinical care; clinical database; cost; demographics; design; effective intervention; effective therapy; food environment; fruits and vegetables; health care service utilization; hospital readmission; hospital utilization; improved; improved outcome; indexing; insight; low socioeconomic status; member; mortality; operation; programs; public health relevance; readmission rates; social; socioeconomic disadvantage; socioeconomics; surgery outcome; surgical service

Project Abstract Severe obesity (body mass index [BMI]>35) affects nearly 20 million adults in the U.S. and is twice as common in adults from the lowest socioeconomic strata compared to the highest. Adults with severe obesity are much more likely to have obesity-related comorbidities, poorer quality of life, and shortened lifespans. Randomized controlled trials and observational studies have found that bariatric surgery provides greater weight loss and comorbidity resolution, better quality of life, and longer lifespans as compared with medical weight management strategies. Using Medicaid status as a way to identify lower socioeconomic status (SES), our preliminary data indicate that lower SES patients who undergo bariatric surgery have worse outcomes than higher SES patients. Among all adults who underwent bariatric surgery in Wisconsin from 2011-2014, Medicaid patients had higher rates of emergency department (ED) visits and readmissions within the first year following bariatric surgery. Similarly, our single institution reviews from two academic medical centers in different states found that Medicaid patients had higher rates of ED visits and readmissions within 90 days of surgery. Medicaid patients also lost significantly less weight than did non-Medicaid patients after bariatric surgery. Reasons for these disparities between Medicaid and non-Medicaid patients undergoing bariatric surgery are unknown. Our long-term goal is to develop and implement effective interventions that will improve the health of adults with severe obesity. Our objective in this application is to identify patient and community-level characteristics that are associated with suboptimal 90-day and 1-year outcomes for Medicaid patients who undergo bariatric surgery. To achieve this, we will use a sequential explanatory design, which includes collection and analysis of quantitative data, followed by collection and analysis of qualitative data. This mixed methods research design will allow us to explain and extend the quantitative findings through additional, qualitative studies. We propose the following two Specific Aims: 1) Identify patient characteristics and community-level determinants of health that are associated with suboptimal outcomes for Medicaid and non- Medicaid bariatric surgery patients; and 2) Understand patient and clinical care team perspectives on how patient, provider, and community-level determinants of health influence outcomes for Medicaid vs. non- Medicaid patients who undergo bariatric surgery.

项目摘要 严重肥胖（体重指数 [BMI]>35）影响着美国近 2000 万成年人，是美国成年人的两倍 与最高社会经济阶层相比，在最低社会经济阶层的成年人中很常见。严重肥胖的成年人 更有可能患有与肥胖相关的合并症、生活质量较差和寿命缩短。 随机对照试验和观察性研究发现，减肥手术可以提供更大的效果。 与医疗相比，体重减轻和合并症得到解决，生活质量更好，寿命更长 体重管理策略。使用医疗补助状况作为识别较低社会经济地位 (SES) 的一种方式， 我们的初步数据表明，接受减肥手术的社会经济地位较低的患者的结果比接受减肥手术的患者更差 较高 SES 的患者。 2011 年至 2014 年威斯康星州所有接受减肥手术的成年人中，医疗补助 患者在术后第一年内急诊科 (ED) 就诊率和再入院率较高 减肥手术。同样，我们来自不同州的两个学术医疗中心的单一机构评论 发现医疗补助患者在手术后 90 天内急诊就诊和再入院的比例较高。 减肥手术后，医疗补助患者的体重减轻也明显少于非医疗补助患者。 接受减肥手术的医疗补助和非医疗补助患者之间存在这些差异的原因是 未知。我们的长期目标是制定和实施有效的干预措施，以改善人们的健康 严重肥胖的成年人。我们在此应用程序中的目标是识别患者和社区级别 与医疗补助患者 90 天和 1 年结果不佳相关的特征 接受减肥手术。为了实现这一目标，我们将使用顺序解释性设计，其中包括 定量数据的收集和分析，然后是定性数据的收集和分析。这个混合的 方法研究设计将使我们能够通过额外的、 定性研究。我们提出以下两个具体目标：1）确定患者特征和 与医疗补助和非医疗补助的次优结果相关的社区层面的健康决定因素 医疗补助减肥手术患者； 2) 了解患者和临床护理团队对如何进行治疗的看法 患者、提供者和社区层面的健康决定因素影响医疗补助与非医疗补助的结果 接受减肥手术的医疗补助患者。