Health Insurance Navigators for the Low-Income Elderly

描述(由申请人提供)：保罗·B·比森老年职业发展奖的候选人是一名接受过正式临床研究培训的普通内科医生。他提出了一项研究和职业发展计划，以现有技能为基础，发展以患者为导向的老龄化相关研究的专业知识，重点是照顾老年人的经济障碍，并开发干预措施来降低这些障碍。老年人医疗保险的复杂性对选择满足个人需求的医疗保险构成了重大挑战，特别是对于低收入、市中心的老年人来说，因为教育程度低、识字问题和其他障碍。新的联邦医疗保险处方药福利将极大地增加这一挑战，因为人们必须权衡无数因素才能做出最佳计划选择。之前为促进老年人的保险决策所做的努力收效甚微。一个原因可能是，这些努力缺乏理论基础或强有力的经验数据来支持这一方法。这个应用程序的目标是在低收入的市中心老年人中经验地识别影响保险决策的因素，并设计一个 便于决策的方法。四个具体目标是：1)确定认知能力的影响 本研究的目的是：评估医疗保险决策中的损害和健康素养；2)制定医疗费用对老年人及其保险信息和决策支持需求的影响的衡量标准；3)测试将跨理论模型的变化阶段结构应用于医疗保险决策过程的有效性；4)开发和评估应用目标1-3的调查结果的干预措施，以提供针对个人特定需求的保险保险决策支持，并考虑到他们对医疗保险做出改变的准备情况。对于AIMS 1-3，我们将带领焦点小组开发一种调查工具，并将对来自东哈莱姆区和纽约布朗克斯区的医院、社区诊所和老年中心的400名老年成年人进行调查。对于目标4，我们将开发一种医疗保险导航器干预，使用训练有素的非专业志愿者来帮助经过需求筛查的患者做出最优的医疗保险决策。我们将在随机对照试验中评估干预措施。这项研究将为临床医生和研究人员提供新的研究和临床工具，扩大对老年人保险决策的理解，并创造一种高效、低成本的方法来帮助老年人优化保险决策。研究结果还将使政策制定者深入了解参与医疗保险自成立以来最大规模扩张的一些最脆弱的老年患者的真实世界经历。职业发展计划包括授课课程、专家建议和指导研究，以发展定性和调查研究方法的技能，并扩大应聘者的临床老年病学知识库。

DESCRIPTION (provided by applicant): The candidate for this Paul B. Beeson Career Development Award in Aging is a general internist with formal clinical research training. He proposes a research and career development plan to build on existing skills and develop expertise in patient-oriented aging-related research, with a focus on financial barriers to care for the elderly and the development of interventions to lower these barriers. The complexities of healthcare coverage for the elderly pose a significant challenge for choosing coverage that meets individual needs, especially for low-income, inner-city seniors because of low education, literacy problems, and other barriers. The new Medicare prescription drug benefit will add greatly to this challenge because of the myriad factors one must weigh to make an optimal plan selection. Previous efforts to facilitate insurance decision making for the elderly have had only modest effects. One reason may be that these efforts have lacked theoretical grounding or strong empirical data to support the approach. The goal of this application is to empirically identify factors that influence insurance decision making among low-income, inner city seniors, and devise a method to facilitate decision making. The 4 specific aims are 1) to determine the influence of cognitive impairment and health literacy on healthcare coverage decisions; 2) to develop measures of the impact of healthcare costs on the elderly, and of their insurance information and decision making support needs; 3) to test the validity of applying the Transtheoretical Model's stages of change construct to the process of healthcare coverage decision making; 4) to develop and evaluate an intervention that applies the findings from Aims 1-3 to provide insurance coverage decision making support that is tailored to the individual's specific needs, and takes into account their readiness to make a change in healthcare coverage. For Aims 1-3, we will conduct focus groups to develop a survey instrument, and will survey 400 elderly adults from hospital and community-based clinics and senior centers in East Harlem and the Bronx, NY. For Aim 4, we will develop a health insurance navigator intervention that uses trained layperson volunteers to assist patients, who have been screened for need, with making optimal healthcare coverage decisions. We will evaluate the intervention in a randomized controlled trial. This research would provide clinicians and investigators with new research and clinical tools, expand understanding of the insurance decision making in older adults, and create an efficient, low cost method to help seniors optimize insurance decisions. Study findings would also give policymakers insight into the real world experience of some of the most vulnerable elderly patients participating in the largest expansion of Medicare since its inception. The career development plan includes didactic courses, expert advising, and mentored research to develop skills in qualitative and survey research methods, and to expand the candidate's clinical geriatrics knowledge base.