Ambulatory Care Access and Quality

描述(由申请人提供)：虽然许多研究指出了与种族/民族、经济和教育相关的健康和医疗保健机会方面的差距，但对残疾人知之甚少，这一群体最近被疾控中心确认为高危人口群体。在这一广泛修订的申请中，我们建议经验性地展示每一次接触、协调和护理质量对“可避免”住院的概率、时间和数量的影响程度，也就是次要于非卧床护理敏感(ACS)条件的住院及其相关费用。具体地说，我们的目标是：(1)确定限制阶段对(I)获得医疗保健的障碍、(Ii)护理协调和质量、(Iii)符合指南的护理的实际接收、(Iv)急性冠脉综合征住院率和()与急性冠脉综合征相关的住院费用的影响的程度；(2)检查获得障碍、护理协调和质量以及实际接受符合指南的护理之间的关系，并评估这些关系是否随限制阶段的不同而变化；(3)确定(I)获得护理的障碍、(Ii)护理协调和质量以及(Iii)实际接受指南合规护理与ACS住院和相关成本相关的程度，以及(4)执行政策模拟以估计旨在(I)减少获得障碍、(Ii)改善护理协调和质量以及(Iii)加强提供指南合规护理在减少与ACS相关的住院和相关成本方面的计划的相对贡献。这些目标将通过分析在10年内汇总的联邦医疗保险当前受益人调查(MCBS)的纵向数据来实现。遵循直接标准化方法，我们将应用两阶段和竞争风险持续时间模型来估计衡量活动限制阶段、访问障碍、协调和感知的护理质量以及遵循指南的护理程度对ACS住院和费用的独立影响。除了通过提供有关残疾人护理方面差异的潜在来源的机械性信息来填补基本的知识空白之外，这项研究还将提供一种创新的 政策模拟将为确定如何最好地分配公共资源，以纠正可避免的住院中的残疾差距并最大限度地节省费用的努力提供信息。

DESCRIPTION (provided by applicant): While many studies point to racial/ethnic, economic, and education-related disparities in health and healthcare access, little is known about people with disabilities, a population recently recognized by the CDC as an at-risk demographic group. In this extensively revised application, we propose to show empirically the extent to which each access, coordination, and quality of care influence the probability, timing and number of "avoidable" hospitalizations, that is, hospitalizations secondary to Ambulatory Care Sensitive (ACS) conditions, and their related costs. Specifically, our aims are to: (1) determine the extent to which stages of limitation influence (i) access barriers to medical care, (ii) care coordination& quality, (iii) actual receipt of guideline compliant care, (iv) rates of ACS hospitalizations and () ACS-related hospitalization costs; (2) examine the relationship between access barriers, care coordination & quality, and actual receipt of guideline compliant care, and evaluate whether these relationships vary according to stages of limitation; (3) determine the extent to which (i) access barriers to care, (ii) care coordination & quality, and (iii) actual receipt of guideline compliant care are associated with ACS hospitalizations and related costs and (4) perform a policy simulation to estimate the relative contribution of programs aimed at (i) reducing access barriers, (ii) improving coordination & quality of care and (iii) enhancing provision of guideline compliant care in reducing ACS-related hospitalizations and associated costs. These aims will be carried out by analyzing longitudinal data from the Medicare Current Beneficiary Surveys (MCBS) aggregated over a 10-year period. Following direct standardization methods, we will apply two-stage and competing risk duration models to estimate the independent effects of measures capturing activity limitation stage, access barriers, coordination & perceived quality of care, and degree of guideline compliant care on ACS hospitalizations and costs. In addition to filling an essential knowledge gap by providing mechanistic information about potential sources of disparities in the care of persons with disabilities, this study will also provide an innovative policy simulation that will inform efforts to determine how best to allocate public resources in order to remediate disability disparities in avoidable hospitalizations and realize the greatest cost savings.