Linking Spatial Access and Health Outcomes for Pediatric Asthma in the Medicaid System: Inferences and Interventions

 描述（由申请人提供）：医疗保健可及性是健康、预防和慢性病管理中积极健康结果的基本原则，与优质护理一起，可以通过预先预防医疗危机和严重结果来减少不同的结果，并降低医疗保健提供成本。虽然在当前的美国卫生政策议程中备受关注，但仅仅改善金融准入并不能全面解决医疗保健准入问题。负担能力是医疗保健的一个障碍，但其他障碍，如可用性和可获得性，同样影响健康和医疗保健的差距。在衡量卫生服务获得情况时，将可获得性和可获得性放在一起考虑的研究称为空间获得。空间无障碍对于管理慢性病尤其重要，因为定期就诊和坚持护理做法可以减少严重后果。该提案将通过制定和实施一个衡量、联系成果和评估空间获取干预措施的框架，促进对医疗保健获取的研究。我们将制定我们的框架，并试点一种慢性呼吸系统疾病，儿童哮喘，针对医疗补助系统中的儿童的方法，并在美国多个州进行比较。我们选择哮喘是因为它是最常见的慢性儿童呼吸系统疾病之一，导致生活质量、成本和发病率的巨大损失。建议的框架采取了系统的方法在建模访问和评估干预措施，占系统中的限制，包括流动性，用户的选择，旅行意愿，医疗补助资格和注册，拥挤和容量限制。我们采用这种方法来量化的措施，在一个大型的网络护理的空间访问。使用这些措施，我们进一步估计的作用，空间访问纵向观察的结果，同时控制潜在的影响因素，严重的结果，使用先进的统计方法。空间访问的建模和推理的目的是确定干预措施，以减少严重的结果，同时增加可及性和可用性的护理。使用优化方法，我们评估干预措施，有效地分配资源，需要照顾的哮喘预算限制下的地区。干预模型建立在用于估计空间访问的系统模型和用于预测访问干预对减少严重健康后果的影响的统计模型的基础上。

 DESCRIPTION (provided by applicant): Healthcare access is a fundamental tenet of positive health outcomes in wellness, prevention and chronic disease management, and together with quality care, can result in less disparate outcomes, and reduced healthcare delivery costs by preempting medical crises and severe outcomes. Although spotlighted in the current U.S. health policy agenda, improving financial access alone does not comprehensively address healthcare access. Affordability is one barrier to healthcare, but others such as availability and accessibiliy equally impact disparities in health and healthcare. The study of availability and accessibility considered together when measuring health service access is referred to as spatial access. Spatial access is particularly important for managing chronic diseases where regular visits and adherence to care practices can reduce severe outcomes. This proposal will contribute to the research on healthcare access through development and implementation of a framework for measuring, linking to outcomes, and evaluating interventions for spatial access. We will develop our framework and pilot the methods on one chronic respiratory condition, pediatric asthma, targeting children in the Medicaid system with a comparison across multiple states in the United States. We selected asthma because it is one of the most prevalent chronic childhood respiratory conditions, contributing to great losses in quality of life, costs, and morbidity. The proposed framework takes a system approach in modeling access and evaluating interventions, accounting for constraints in the system including mobility, user choice, willingness to travel, Medicaid eligibility and enrollment, congestion and capacity constraints. We apply this approach to quantify measures of spatial access across a large network of care. Using these measures, we further estimate the role that spatial access has on longitudinally observed outcomes while controlling for potentially contributing factors to severe outcomes, using advanced statistical methods. The aim of the modeling and inference on spatial access is to identify interventions for reducing severe outcomes while increasing accessibility and availability of care. Using optimization methods, we evaluate interventions by effectively allocating resources to areas in need of care for asthma under budget constraints. The intervention models build on the system model for estimating spatial access and on the statistical models for projecting the impact of access intervention on reducing severe health outcomes.