Built Environment and Health Care Use: Disparities Among Chronically Ill Elders

建筑环境和医疗保健使用：慢性病老年人之间的差异

• 批准号: 8240350
• 负责人: Miriam Ryvicker
• 金额: $ 16.08万
• 依托单位: VISITING NURSE SERVICE OF NEW YORK
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8240350
• 关键词: Accident and Emergency department; Address; Age; Ambulatory Care; Area; Award; Caring; Characteristics; Chronic; Chronic Disease; Chronically Ill; Clinical; Communities; Comorbidity; Congestive Heart Failure; County; Data; Diabetes Mellitus; Diagnosis; Dimensions; Economic Factors; Economics; Elderly; Environment; Environmental Risk Factor; Epidemiology; Equation; Foundations; Frequencies; Goals; Health; Health Service Area; Health Services Accessibility; Healthcare; Hospitalization; Improve Access; Individual; Life; Link; Low income; Measures; Medicare; Mentored Research Scientist Development Award; Minority; Modeling; Neighborhoods; New York City; Outcome; Patients; Physicians; Provider; Quality of Care; Quality of life; Research; Research Activity; Sampling; Services; Socioeconomic Status; Sorting - Cell Movement; Source; Techniques; Testing; Time; Training; Training Activity; Transportation; Variant; Visit; Vulnerable Populations; Walking; base; beneficiary; burden of illness; demographics; effective intervention; geographic difference; health disparity; health economics; insight; longitudinal analysis; medical supply; prevent; racial and ethnic disparities; social; socioeconomics; therapy design

DESCRIPTION (provided by applicant): Associations between characteristics of the neighborhoods in which older people live and late-life disparities in chronic illness have been the subject of a rapidly growing field of research. For low-income and minority elders with chronic illness, disparities in access to and quality of care contribute to disparities in the burden of illness. Research on chronic illness has also underscored the links between inadequate physician oversight, potentially preventable hospitalizations, and poor health outcomes. However, little is known about the ways in which neighborhood environmental factors - beyond local supply of medical services - inform how urban older adults with chronic illness use physician services to manage their health. This study addresses this gap by examining the relationships between neighborhood built environment (e.g. walk-ability, access to public transit), use of physician services, and preventable hospitalizations and emergency department visits among elderly, chronically ill Medicare beneficiaries who live in New York City. Specifically, the study aims to: 1) Examine associations between neighborhood built environment and physician service use among urban, chronically ill older adults; 2) Determine whether and to what extent variations in the built environment influence potentially preventable hospitalizations and emergency department visits; and 3) Reassess findings from Aims 1 and 2 by applying: (i) alternative modeling techniques; and (ii) tests of endogeneity to address the potential sorting of patients into neighborhoods with different characteristics based on service use and outcomes. The study will be based on longitudinal analysis of existing data on a sample of NYC-dwelling Medicare beneficiaries age 65 and older, linking individual characteristics and service use measures with small area- level data from other sources. Analyses will focus on patients with congestive heart failure and diabetes - two major contributors to preventable hospitalizations. This study will provide insight into the interdependence of clinical, social, economic, and environmental factors that influence quality of chronic illness care and, ultimately, quality of life, for older adults with multiple co-morbidities. The proposed research will apply and expand on the candidate's training throughout the K01 award period, including advanced methodological training in epidemiology and health economics. The training and research activities will lay the foundation for an R01 application in the later years of the award. Findings from this study and future research will ultimately be applied toward developing effective interventions to improve access to, continuity, and quality of ambulatory care for chronically ill elders living in underserved communities and, in turn, mitigate late-life health disparities. PUBLIC HEALTH RELEVANCE: Significant socio-economic and racial/ethnic disparities exist in the burden of chronic illness among older adults, due partly to disparities in access to and quality of ambulatory care aimed at preventing chronic illness complications. Although prior research has examined geographic variations in health care access across areas such as counties, little is known about how variations in environmental and socio-economic factors at the neighborhood level influence disparities in service use and outcomes among vulnerable groups, particularly low-income and minority elders. This study aims to address this gap by examining the relationships between neighborhood built environment, use of physician services, and preventable hospitalizations and emergency department visits among elderly, chronically ill Medicare beneficiaries who live in New York City.

描述（由申请人提供）：老年人生活的社区特征与慢性病的晚年差异之间的关联一直是一个快速增长的研究领域的主题。对于患有慢性病的低收入和少数族裔老年人来说，在获得护理和护理质量方面的差异导致了疾病负担的差异。对慢性病的研究也强调了医生监督不足、潜在可预防的住院治疗和不良健康结果之间的联系。然而，人们对社区环境因素（除了当地的医疗服务供应）如何告知患有慢性病的城市老年人如何使用医生服务来管理他们的健康知之甚少。本研究通过检查居住在纽约市的老年慢性病医疗保险受益人的社区建筑环境（例如步行能力，公共交通），使用医生服务，可预防的住院和急诊室就诊之间的关系来解决这一差距。具体而言，该研究旨在：1）检查社区建筑环境与城市慢性病老年人使用医生服务之间的关联; 2）确定建筑环境的变化是否以及在多大程度上影响潜在可预防的住院和急诊就诊; 3）通过应用以下方法重新评估目标1和2的结果：（i）替代建模技术;以及（ii）内分泌测试，以解决根据服务使用和结果将患者分为具有不同特征的社区的可能性。 该研究将基于对纽约市居住的65岁及以上医疗保险受益人样本的现有数据的纵向分析，将个人特征和服务使用措施与其他来源的小区域数据联系起来。分析将集中在充血性心力衰竭和糖尿病患者-两个主要贡献者可预防的住院治疗。这项研究将深入了解临床，社会，经济和环境因素的相互依赖性，这些因素影响慢性病护理的质量，并最终影响患有多种共病的老年人的生活质量。拟议的研究将在整个K 01奖期间应用和扩展候选人的培训，包括流行病学和卫生经济学的高级方法学培训。培训和研究活动将为该奖项后期的R 01申请奠定基础。这项研究的结果和未来的研究将最终应用于制定有效的干预措施，以改善生活在服务不足社区的慢性病老年人的门诊护理的可及性、连续性和质量，从而减轻晚年健康差距。 公共卫生相关性：在老年人慢性病负担方面存在重大的社会经济和种族/族裔差异，部分原因是在获得旨在预防慢性病并发症的流动护理的机会和质量方面存在差异。虽然先前的研究已经研究了跨地区（如县）医疗保健服务的地理差异，但人们对社区一级环境和社会经济因素的变化如何影响弱势群体（特别是低收入和少数民族老年人）在服务使用和结果方面的差异知之甚少。本研究旨在通过检查居住在纽约市的老年慢性病医疗保险受益人之间的邻里建筑环境，使用医生服务，可预防的住院和急诊室就诊之间的关系来解决这一差距。