Caregiving and Health Care Utilization after Stroke among Medicare Beneficiaries

描述(由申请人提供)：在美国，中风是导致长期严重残疾的主要原因。女性和非裔美国人在中风后的功能结果通常较差，尽管这些性别和种族差异的原因尚不清楚。中风对女性和非裔美国人的不同影响可能可以通过不同的急性治疗和急性后康复服务，以及对非正式家庭照顾者的不同支持来解释。这些因素很少在卒中幸存者的代表性人群样本中进行研究。这项申请寻求资金，在全国中风幸存者样本中研究这些因素，这些幸存者也是联邦医疗保险的受益者。CARE(CARE)研究是对全国中风地理和种族差异原因(CONTS)项目的辅助研究，也是唯一一项系统地收集大规模前瞻性流行病学调查中发现的突发中风事件幸存者的长期功能结果数据的同类研究。初级家庭照顾者也参加了CARE项目，到目前为止，已有210名中风幸存者/家庭照顾者夫妇参加了该项目。大多数中风幸存者(N=183，87%)是传统的医疗保险受益人，医疗保险声称他们的急性住院和急性后康复或康复阶段的数据是可用的。卒中幸存者的功能结果在卒中事件发生后大约一年的结构化家庭评估中进行评估，卒中幸存者和家庭照顾者的心理社会功能和生活质量通过结构化电话访谈进行评估，从卒中事件发生后9个月开始，一直持续到卒中事件发生后3年。作为CARE项目拟议扩展的一部分，我们将扩大纳入标准，以纳入更多中风幸存者，包括那些没有家庭照顾者的人，我们的总样本量将增加到420名中风幸存者，其中包括365名也是传统医疗保险受益人的人。在继续研究所有中风幸存者的结果差异的同时，这项提案提出了新的具体目标，重点是从医疗保险索赔数据中衡量医疗保健利用情况。以前关于中风后的护理利用和中风的长期结果的大多数研究都没有评估非正式家庭照顾者的影响或经历，我们假设照顾者可获得性和参与度的差异将部分解释先前观察到的护理利用和功能结果的性别和种族差异。CARE项目具有独特的定位，可以将人口统计变量、中风严重程度测量、中风后护理利用模式、非正式护理因素和长期功能结果联系起来，从而为为什么女性和非裔美国人中风后预后较差的文献增加新的知识。该项目还将在更广泛的范围内促进我们对中风如何影响患者及其家人的总体理解。

DESCRIPTION (provided by applicant): Stroke is a leading cause of serious long-term disability in the United States. Women and African Americans commonly have poorer functional outcomes after stroke, although the reasons for these gender and race differences are poorly understood. Some of the differential impact of stroke on women and African Americans might be explained by differential acute treatment and post-acute rehabilitative services, and by differential support of informal family caregivers. These factors have rarely been studied in representative population- based samples of stroke survivors. This application seeks funding to study these factors in a national sample of stroke survivors who are also Medicare beneficiaries. The Caring for Adults Recovering from the Effects of Stroke (CARES) study is an ancillary study of the national REasons for Geographic and Racial Differences in Stroke (REGARDS) project and is the only study of its kind that is systematically collecting long-term functional outcome data from the survivors of verified incident stroke events that are detected in a large-scale, prospective, epidemiologic investigation. Primary family caregivers are also enrolled in the CARES project, and to date, 210 stroke survivor/ family caregiver dyads have been enrolled. Most of these stroke survivors (N = 183, 87%) are traditional Medicare beneficiaires for whom Medicare claims data for the acute hospitalization and post-acute rehabilitative or recovery phase are available. Stroke survivor functional outcomes are assessed during structured in-home evaluations approximately one year after the incident stroke events, and stroke survivor and family caregiver psychosocial functioning and quality of life are assessed with structured telephone interviews beginning 9 months after the incident stroke event and continuing up to 3 years after the stroke event. As part of this proposed extension to the CARES project, we will expand our inclusion criteria to include more stroke survivors, including those without family caregivers, and our total sample size will increase to 420 stroke survivors, including 365 who are also traditional Medicare beneficiaries. While continuing to study outcome disparities among all stroke survivors, new specific aims are advanced in this proposal that focus on measures of health care utilization from the Medicare claims data. Most of the previous studies on care utilization after stroke and the long-term outcomes of stroke have not assessed the influences or experiences of informal family caregivers, and we hypothesize that differences in caregiver availability and involvement will partially explain previously observed gender and race differences in care utilization and functional outcomes. The CARES project is uniquely positioned to link demographic variables, stroke severity measures, post-stroke care utilization patterns, informal caregiving factors, and long-term functional outcomes in ways that will add new knowledge to the literature on why women and African Americans have poorer outcomes after stroke. The project will also advance our general understanding of how stroke affects both patients and their families more broadly.