Disparities in Post-Acute Rehabilitation Care

描述(由申请人提供)：这项研究的广泛长期目标是为制定干预措施提供信息，这些干预措施将改善服务不足人群获得、使用和提高急性后康复护理的质量。这项拟议研究的主要目标是更彻底和更新地了解髋部骨折、关节置换和中风后急性康复护理使用方面的差异。这项研究建议汇集和分析来自四个地理和人口统计不同的州(亚利桑那州、佛罗里达州、新泽西州、威斯康星州)的州特定医院出院数据。医院出院数据将与美国医院协会年度调查数据库、地区资源文件和美国人口普查数据合并。将对离散结果进行描述性、双变量和多变量回归分析，包括多水平分析，以实现以下具体目标： 1)说明在使用急性康复护理方面的社会人口(种族、族裔、年龄、性别、社会经济地位)和地理差异(城市/农村、州)。通过对数据的描述性和双变量分析，我们将确定急性后康复护理的使用程度因每个社会人口和地理特征而异。 2)确定其他观察到的特征在多大程度上解释了已确定的社会人口和地理差异。通过一系列多变量分析，检查与急性后康复护理的使用有关的个人和社区一级的特征，并通过使用分解技术，我们将确定其他观察到的特征在多大程度上解释了已查明的差异。更具体地说，我们将确定已确定的差异的程度：a.被其他观察到的特征混淆(例如，保险状况和/或疾病严重性可能解释使用上的一些种族差异；婚姻状况可能解释使用上的一些性别差异)；b.受到其他观察到的特征的调节(例如，低收入和高收入少数群体在使用上的差异可能不同)；c.由个人和社区层面的特征解释(我们假设个人和社区层面的因素都会解释使用上的差异)；以及D.无法解释这项研究中检查的特征(我们假设一些已确定的使用差异将无法解释)。公共卫生相关性：急性后康复护理是一个有效且不断增长的卫生保健领域，但尚未对卫生保健差距进行充分调查。查明急性后康复护理方面存在差异的程度并确定造成这些差异的根本原因，是制定干预措施以消除这些差异的必要的第一步。

DESCRIPTION (provided by applicant): The broad long-term objective of this research is to inform the development of interventions that will improve access to, use of, and quality of post-acute rehabilitation care for underserved populations. The primary objective of the proposed study is to gain a more thorough and current understanding of disparities in the use of post-acute rehabilitation care following hip fracture, joint replacement, and stroke. This study proposes to pool and analyze state-specific hospital discharge data from four geographically and demographically diverse states (AZ, FL, NJ, WI). The hospital discharge data will be merged with data from the American Hospital Association Annual Survey database, the Area Resource File, and U.S. Census data. Descriptive, bivariate, and multivariable regression analyses for discrete outcomes, including multi-level analyses, will be conducted for each condition to achieve the following specific aims: 1) Describe the sociodemographic (race, ethnicity, age, gender, socioeconomic status) and geographic disparities (urban/rural, state) in the use of post-acute rehabilitation care. Through descriptive and bivariate analyses of the data, we will determine the extent to which use of post-acute rehabilitation care varies by each sociodemographic and geographic characteristic. 2) Determine the extent to which identified sociodemographic and geographic disparities are explained by other observed characteristics. Through a series of multivariable analyses examining individual and community-level characteristics associated with the use of post-acute rehabilitation care and through the use of decomposition techniques we will determine the extent to which the identified disparities are explained by other observed characteristics. More specifically, we will determine the extent to which the identified disparities are: a. confounded by other observed characteristics (e.g., insurance status and/or disease severity may explain some of the racial differences in use; marital status may explain some of the gender differences in use); b. moderated by other observed characteristics (e.g., disparities in use may differ for low income and high income minorities); c. explained by individual versus community-level characteristics (we hypothesize that both individual and community-level factors will explain differences in use); and d. unexplained by the characteristics examined in this study (we hypothesize that some of the identified differences in use will be unexplained). PUBLIC HEALTH RELEVANCE: Post-acute rehabilitation care is an effective and growing area of health care that has not been adequately investigated in regard to health care disparities. Identifying the extent to which disparities exist in post-acute rehabilitation care and determining underlying reasons for these disparities are necessary first steps in developing interventions to eliminate these disparities.