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

 说明(申请人提供)：医疗保健服务是在健康、预防和慢性病管理方面取得积极健康成果的一项基本原则，与高质量的护理相结合，可以减少不同的结果，并通过预防医疗危机和严重后果降低医疗保健提供成本。尽管在当前的美国卫生政策议程中备受关注，但单靠改善资金获取并不能全面解决医疗保健获取问题。负担能力是医疗保健的一个障碍，但其他障碍，如可获得性和可获得性，同样影响健康和医疗保健方面的差距。在衡量卫生服务可获得性时将可获得性和可及性一并考虑的研究称为空间可获得性。空间准入对于管理慢性病尤其重要，在慢性病中，定期就诊和遵守护理做法可以减少严重后果。这项提案将通过制定和实施衡量、联系成果和评估空间获取干预措施的框架，促进医疗保健获取方面的研究。我们将制定我们的框架，并试验针对一种慢性呼吸道疾病--儿童哮喘--的方法，目标是医疗补助系统中的儿童，并在美国多个州进行比较。我们选择哮喘是因为它是儿童时期最常见的慢性呼吸道疾病之一，导致生活质量、成本和发病率的极大损失。拟议的框架采用系统方法来模拟准入和评估干预措施，考虑到系统中的限制因素，包括流动性、用户选择、旅行意愿、医疗补助资格和参保人数、拥堵和容量限制。我们应用这种方法来量化大型护理网络中空间获取的度量。使用这些测量方法，我们进一步估计空间访问对纵向观察结果的作用，同时使用先进的统计方法控制可能导致严重结果的因素。关于空间准入的建模和推断的目的是确定减少严重后果的干预措施，同时增加护理的可及性和可得性。使用最优化方法，我们通过在预算限制下有效地将资源分配到需要治疗哮喘的地区来评估干预措施。干预模型建立在估计空间获取的系统模型和预测获取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.