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Urban-Rural Disparities in Healthcare Quality for Children with Complex or Disabling Health Conditions

复杂或残疾儿童医疗质量的城乡差异

基本信息

批准号：
10090639
负责人：
JoAnna Leyenaar
金额：
$ 75.67万
依托单位：
DARTMOUTH-HITCHCOCK CLINIC
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-01-28 至 2023-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10090639
关键词：
Adult Ambulatory Care American Area Attenuated Caring Characteristics Child Child Care Child health care Childhood Chronic Chronic Disease Clinical Colorado Community Health Systems Complex Data Disease Management Emergency Situation Emergency department visit Ethnic Origin Ethnic group Evaluation Foundations Future Geography Health Health Personnel Health system Healthcare Healthcare Systems High Prevalence Hospital Charges Hospitalization Inpatients Insurance Intervention Knowledge Length of Stay Massachusetts Measures Medical Medicare New Hampshire Outcome Pathway Analysis Patients Pattern Patterns of Care Pediatric Hospitals Physicians Population Population Heterogeneity Poverty Preventive care Preventive healthcare Primary Health Care Provider Public Health Quality of Care Race Reporting Research Resources Retrospective cohort study Risk Rural Services Social Network Specialist Structure Surveys Time Travel Underserved Population United States Vulnerable Populations Work adverse outcome base beneficiary care outcomes care providers care systems clinical care complex chronic conditions cost disability effective intervention experience health care availability health care disparity health care quality health care service utilization health disparity high risk hospital readmission improved improved outcome medical specialties multidisciplinary novel organizational structure peer racial and ethnic readmission risk rural area rural disparities rural health disparities rural residence rural setting rurality tertiary care urban area urban setting

项目摘要

PROJECT SUMMARY/ABSTRACT A total of 11.8 million children live in rural areas of the United States, and one-quarter of these children have chronic health conditions. This population is more likely to have disabilities, less likely to receive preventative care, and more likely to report unmet healthcare needs than children who live in urban areas. As such, they represent an underserved group at high risk for disparities in health outcomes. Children with complex or disabling health conditions may be at particular risk of adverse outcomes when they live in rural areas due to their chronic and multifaceted healthcare needs. However, at a population level we know extremely little about how urban-rural disparities in health care access impact this vulnerable population. The overall objective of this proposal is to comprehensively evaluate urban-rural disparities in health care utilization and quality for children with complex or disabling health conditions using five years of all-payer claims data from three states: Colorado, Massachusetts and New Hampshire. These states represent diverse populations with respect to geography, rurality, and race/ethnicity, making them ideally suited to the proposed analyses. We will conduct a retrospective cohort study of approximately 140,000 children to: (i) identify urban-rural disparities in ambulatory, emergency and inpatient healthcare utilization, (ii) characterize urban-rural disparities in healthcare quality, (iii) identify community and health-system factors associated with urban-rural disparities in healthcare quality, and (iv) construct patient-sharing networks among physicians who care for these children to determine how patient-sharing networks differ between rural- and urban-residing children, and whether these differences are associated with disparities in quality of care. Construction of physician patient-sharing networks – that is, structural representations of relationships between physicians developed on the basis of shared patients -– provides a systematic approach to identify relationships between physicians that exist outside of formal organizational structures, which may be particularly relevant to children living in rural areas. In adult populations, network characteristics have been associated with resource utilization, practice patterns, and healthcare outcomes. However, this study will be the first to explore how physician networks differ between urban- and rural-residing children, characterizing a modifiable health system factor that may be leveraged in future work to reduce urban-rural disparities in their quality of care. This project will be conducted by a multidisciplinary team with clinical expertise providing care for children with medical complexity, as well as research expertise using all-payer claims data to evaluate healthcare quality and construct social networks. This research will generate essential data to inform the subsequent implementation and evaluation of interventions to reduce health disparities for rural-residing children with complex or disabling health conditions.

项目总结/摘要共有1180万儿童生活在美国农村地区，其中四分之一的儿童慢性健康状况。这一人群更有可能患有残疾，不太可能接受预防性治疗。与生活在城市地区的儿童相比，儿童更有可能报告未得到满足的医疗保健需求。所以他们代表着一个在健康结果方面存在差异的高风险的得不到充分服务的群体。患有复杂或残疾人在农村地区生活时，由于以下原因，他们的慢性和多方面的医疗保健需求。然而，在人口水平上，城乡在获得保健服务方面的差距如何影响这一弱势群体。本报告的总体目标建议综合评价城乡儿童卫生服务利用和质量的差异使用来自三个州的五年所有付款人索赔数据，患有复杂或残疾的健康状况：科罗拉多，马萨诸塞州和新罕布什尔州。这些国家代表了不同的人口，地理、农村和种族/民族，使其非常适合拟议的分析。我们将进行对大约140 000名儿童进行的回顾性队列研究，目的是：㈠查明城乡在以下方面的差距：门诊、急诊和住院医疗利用率，（二）（三）确定与城乡差距有关的社区和卫生系统因素，医疗质量，以及（iv）在照顾这些儿童的医生之间建立患者共享网络，确定农村和城市儿童之间的患者共享网络有何不同，以及这些网络是否差异与护理质量的差异有关。构建医患共享网络 - 也就是说，医生之间的关系的结构表示是在共享的基础上发展起来的。患者-提供了一种系统的方法来识别医生之间的关系，存在于外部正式的组织结构，这可能与生活在农村地区的儿童特别相关。成人人口，网络特征与资源利用，实践模式，医疗结果。然而，这项研究将是第一个探索医生网络之间的差异的研究。城市和农村居住的儿童，其特点是一个可以改变的卫生系统因素，今后的工作是缩小城乡保健质量差距。该项目将由一名具有临床专业知识的多学科团队，为具有医学复杂性的儿童提供护理，以及研究专业知识，使用所有付款人索赔数据来评估医疗质量和构建社交网络。这项研究将产生必要的数据，为随后的执行和评估提供信息。采取干预措施，减少患有复杂或残疾健康状况的农村儿童的健康差距。