A theoretical framework and mixed-methods investigation of documentation status as a social determinant of emergency care utilization in adult safety-net patients

文件状况作为成人安全网患者紧急护理利用的社会决定因素的理论框架和混合方法调查

• 批准号: 10617118
• 负责人: Cynthia Nicole Ramirez
• 金额: $ 3.41万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10617118
• 关键词: theoretical; framework; mixed; methods; investigation

PROJECT SUMMARY/ABSTRACT BACKGROUND: As a historically minoritized and marginalized population, undocumented immigrants residing in the US face unique and intersecting social and structural inequities in health care access and outcomes. Undocumented immigrants are significantly more likely to report limited access to health insurance coverage, less use of preventive health services, and worse health outcomes as compared to their documented counterparts. Due in-part to exclusionary policies limiting access to comprehensive health insurance coverage, many undocumented immigrants are left with little to no choice but to search for alternative care seeking strategies, including use of safety net emergency departments (EDs) for potentially preventable conditions when experiencing health needs. However, undocumented immigrants remain largely underrepresented in the emergency care utilization literature. ED utilization for ambulatory sensitive care conditions (ACSCs) - conditions for which good outpatient care and early intervention can prevent complications, hospitalization, or more severe disease – are a costly form of health care that have been associated with various social determinants of health, including lack of insurance, however, documentation status as a social determinant of ED utilization for ACSCs is notably missing in the health utilization literature. METHODS: I propose an in-depth investigation of documentation status as a social determinant of ED utilization for ACSCs and non-ACSC in the safety-net setting. In addition to studying the ED care seeking behaviors of adult safety-net patients by various demographic and clinical factors, I will also use project results to propose policy and program solutions for reducing inequities in care and access in the safety-net setting. To accomplish these objectives, I will pursue the following specific aims: 1) Use a traditional grounded theory approach to conduct n=25-30 qualitative interviews on various interpersonal, sociocultural, and structural influences of emergency care seeking behaviors in documented and undocumented adult patients; 2) Use a concatenated, county-wide administrative, billings, and claims dataset to identify demographic and clinical characteristics of potentially preventable vs. non-preventable emergency department utilization among documented and undocumented adult patients at an urban safety-net ED; and 3) Merge datasets from Specific Aims 1-2 and conduct a comprehensive mixed-methods analysis of how various clinical, interpersonal, sociocultural, and structural influences of emergency care seeking intersect, diverge, and converge among and within distinct case-comparison groups – including reason for admission and disposition, country of birth and primary language, and insurance type and housing status - in documented and undocumented adult patients at an urban, safety-net ED. RESULTS: By providing a comprehensive understanding of documentation status as a social determinant of ED utilization in the safety- net setting, this project will help identify the best immediate and long-term policy and program solutions for improving access to equitable, quality healthcare for documented and undocumented safety-net ED patients.

项目概要/摘要 背景：作为历史上的少数群体和边缘化群体，无证移民 居住在美国的人在获得医疗保健和服务方面面临着独特且相互交叉的社会和结构性不平等 结果。无证移民更有可能报告获得医疗服务的机会有限 与其他国家相比，保险覆盖范围、预防性医疗服务的使用较少以及健康结果更差 他们的记录对应物。部分原因是排他性政策限制了获得全面健康的机会 保险范围，许多无证移民几乎别无选择，只能寻找 寻求替代护理策略，包括使用安全网急诊科 (ED) 遇到健康需求时出现可预防的状况。然而，无证移民仍然大部分 在紧急护理利用文献中代表性不足。急诊科用于门诊敏感护理 病症 (ACSC) - 良好的门诊护理和早期干预可以预防的病症 并发症、住院或更严重的疾病——是一种昂贵的医疗保健形式， 然而，与健康的各种社会决定因素有关，包括缺乏保险、文件记录 在健康利用中，ACSC 的 ED 使用的社会决定因素的地位明显缺失 文学。方法：我建议对文献状况作为社会决定因素进行深入调查 安全网环境中 ACSC 和非 ACSC 的 ED 使用情况。除了研究 ED 护理寻求 成人安全网患者的行为受各种人口和临床因素的影响，我还将使用项目 结果提出政策和方案解决方案，以减少安全网中护理和获取方面的不平等 环境。为了实现这些目标，我将追求以下具体目标：1）使用传统的 扎根理论方法对各种人际、社会文化、 有证和无证成人的紧急护理寻求行为的结构性影响 患者; 2) 使用串联的全县行政、账单和索赔数据集来识别 潜在可预防与不可预防紧急情况的人口和临床特征 城市安全网急诊科有证和无证成年患者的科室利用率；和 3) 合并特定目标 1-2 中的数据集，并对如何进行全面的混合方法分析 寻求紧急护理的各种临床、人际、社会文化和结构影响相互交叉， 不同病例比较组之间和内部的分歧和趋同——包括入院原因 和性格、出生国家和主要语言、保险类型和住房状况 - 在 城市安全网急诊室的有证和无证成年患者。结果：通过提供 全面了解文件状况作为安全使用 ED 的社会决定因素 净设置，该项目将有助于确定最佳的近期和长期政策和计划解决方案 改善有证和无证安全网急诊患者获得公平、优质医疗保健的机会。