Improving Native American Elder Access to and Use of Healthcare through Effective Health System Navigation

通过有效的卫生系统导航，改善美国原住民老年人获得和使用医疗保健的机会

• 批准号: 9103209
• 负责人: Cathleen E. Willging
• 金额: $ 50.2万
• 依托单位: PACIFIC INSTITUTE FOR RES AND EVALUATION
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-07-01 至 2019-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9103209
• 关键词: Address; Administrator; Adult; Affect; Affordable Care Act; Age; Aging; American; American Indians; Belief; Caring; Chronic; Collaborations; Communication; Communities; Cost Sharing; Coupled; Data; Deductibles; Development; Elderly; Eligibility Determination; Enrollment; Environment; Evaluation; Evaluation Research; Focus Groups; Funding; General Population; Government; Health; Health Care Reform; Health Insurance; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Home environment; Improve Access; Indian reservation; Inequality; Insurance; Insurance Coverage; Intervention; Interview; Knowledge; Laws; Life Expectancy; Light; Managed Care Programs; Mediation; Medicaid; Medical; Medicare; Medicare/Medicaid; Mental disorders; Methods; Modeling; Morbidity - disease rate; Native Americans; New Mexico; Outcome; Parents; Patients; Persons; Physically Handicapped; Policies; Population; Poverty; Procedures; Process; Provider; Public Sector; Quality of life; Research; Research Design; Research Institute; Research Proposals; Reservations; Resources; Running; Services; Structure; System; Techniques; Tribes; Underserved Population; Uninsured; United States Indian Health Service; Universities; Vulnerable Populations; Work; care seeking; care systems; concept mapping; ethnic minority population; experience; health care availability; health care disparity; health disparity; health literacy; help-seeking behavior; improved; information gathering; innovation; literacy; neglect; novel; outreach; prevent; programs; racial minority; social stigma; tribal leader

 DESCRIPTION (provided by applicant): Major public insurance reforms of the past two decades, i.e., those requiring enrollment into managed care programs, have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older, who suffer from poorer quality of life and lower life expectancies compared to all other aging populations in the U.S. American Indian elders represent a neglected group within the nation's healthcare system. Despite the pervasive belief that the Indian Health Service (IHS) will fully address their health-related needs, elders are negatively affected by gaps in insurance and lack of access to healthcare. Since 2014, the Patient Protection and Affordable Care Act, plus state Medicaid expansion, has made it possible for American Indian elders who are not yet eligible for Medicare to benefit from healthcare coverage. The Affordable Care Act is also intended to improve access to and quality of services for seniors in Medicare and includes special provisions to ameliorate healthcare disparities for American Indians. This proposed five-year, community-driven study features a mixed-method, participatory research design to examine insurance-related outreach activities under the Affordable Care Act, help-seeking behavior, and the healthcare experiences of American Indian elders in New Mexico, home to 22 federally-recognized Pueblos and Tribes. This study combines qualitative and quantitative interviews with concept-mapping techniques and focus groups. The information gathered will generate new practical knowledge, grounded in the actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will also inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of healthcare by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on the AIE population, and will offer a replicable model for enhancing the effects of the Affordable Care Act on other underserved groups affected by inequities in healthcare.

 描述（由申请人提供）：过去二十年的主要公共保险改革，即，那些需要登记进入管理式护理计划的人，未能实质性地解决一般美洲印第安人的医疗保健需求，更不用说55岁及以上的美洲印第安人老年人的特殊需求了，与美国所有其他老龄化人口相比，他们的生活质量较差，预期寿命较低。美洲印第安人老年人代表了国家医疗保健系统中被忽视的群体。尽管人们普遍认为，印度卫生服务（IHS）将充分满足他们的健康相关需求，但老年人受到保险缺口和缺乏医疗保健的负面影响。自2014年以来，《患者保护和平价医疗法案》，加上州医疗补助计划的扩大，使尚未有资格享受医疗保险的美国印第安老人能够受益于医疗保险。《平价医疗法》还旨在改善老年人获得医疗保险服务的机会和服务质量，并包括改善美洲印第安人医疗保健差距的特别规定。这项为期五年的社区驱动的研究采用了混合方法，参与式研究设计，以检查根据《平价医疗法案》开展的与保险相关的外展活动，寻求帮助的行为，以及新墨西哥州美国印第安人老年人的医疗保健经验，这是22个联邦认可的普韦布洛和部落的所在地。本研究结合定性和定量访谈与概念图技术和焦点小组。收集的信息将产生新的实用知识，立足于美国印第安人长者和其他相关利益攸关方的实际观点，以改善医疗保健实践和政策，为在很大程度上被排除在国家和州医疗保健改革讨论之外的人口服务。研究数据还将为制定和评估文化定制的方案提供信息，以加强对美国印第安人老年人不断变化的医疗保健格局的理解和促进谈判。这项工作将填补公共保险计划研究的空白，这些计划通常不关注AIE人群，并将提供一个可复制的模式，以增强《平价医疗法案》对受医疗保健不公平影响的其他服务不足群体的影响。