Factors Associated with Reducing Diabetes-Related Disparities of Rural Latinos

摘要 与减少农村拉丁美洲人糖尿病相关差异相关的因素 我们提出了一项研究性学习，这将大大扩大学生参与研究的机会， 有助于他们了解农村人口的医疗保健服务需求，并促进研究 在我们的大学关于少数民族/种族农村人口的医疗保健，特别是农村拉丁美洲人。的 拟议的研究涉及整个农村人口之间的健康差距问题， 尤其是农村的拉丁裔居民。美国拉丁裔人口正在快速增长。作为一个群体，他们 患糖尿病的风险很高与其他群体相比，他们超重或肥胖的比例很高， 肥胖，这是与2型糖尿病相关的危险因素之一（疾病控制中心和 预防，2014年）。糖尿病并发症很严重，对患者和医疗保健来说成本高昂 整个系统。迄今为止，人们对责任关怀组织的潜在影响知之甚少 （ACO）在医疗保健中的种族/种族差异（Pollack和Armstrong，2011）。了解ACO如何影响这些 不平等是特别重要的，因为一些少数群体，如拉丁美洲人，非洲裔美国人， 美洲原住民更多地集中在农村地区（医学研究所，2005年）。我们提出了一个 纵向研究，其目的是：1）比较农村地区的健康差异和患者结局 拉丁裔老年糖尿病患者与非拉丁裔白色患者比较，2）确定 农村初级保健提供者参与ACO（沿着其他因素）对农村拉丁裔老年人影响 患者本研究有两个目的：目的1：测量糖尿病相关住院率的差异 在医疗保险ACO的农村拉丁裔老年患者和农村非拉丁裔白色老年患者之间， 目的2：确定农村地区糖尿病相关住院率差异缩小的相关因素， 拉丁裔老年患者，包括参加Medicare ACO的RHC。我们将应用一个前后设计 将Medicare ACO参与视为干预措施。该项目将使用为期四年的数据， 医疗保险ACO开始（2008 - 2011）和之后的四年期（2012 - 2015）。该项目将 分三个主要阶段进行：1）从多个数据库收集、合并和组织二级数据。 来源; 2）研究和构建包括在分析中的变量;以及3）进行单变量， 二元和多元分析。这项研究将有助于农村卫生研究， 了解：1）有助于最大限度地减少农村拉丁美洲人与糖尿病相关的健康差异的因素 成人，2）ACO的糖尿病预防护理效果，以及3）最有益于 拉丁裔农村患者

ABSTRACT Factors Associated with Reducing Diabetes-Related Disparities of Rural Latinos We propose a research study that would greatly expand the opportunity for students to be involved in research, contribute to their knowledge about the healthcare service needs of rural populations, and stimulate research at our university about healthcare for minority ethnic/racial rural populations, especially rural Latinos. The proposed study addresses the problem of health disparities among rural populations as a whole, and among rural Latino residents specifically. The U.S. Latino population is growing at a rapid pace. As a group, they are at a high risk for developing diabetes. Compared to other groups, they have high percentages of overweight or obesity, which are among the risk factors associated with Type 2 diabetes (Centers for Disease Control and Prevention, 2014). The complications of diabetes are serious and costly to the patient and the healthcare system as a whole. To date, little is known about the potential impact of Accountable Care Organizations (ACOs) on ethnic/racial disparities in healthcare (Pollack & Armstrong, 2011). Knowing how ACOs affect these disparities is particularly essential because some minority groups, such as Latinos, African Americans, and Native Americans, are more concentrated in rural areas (Institute of Medicine, 2005). We propose a longitudinal study, the purpose of which is to: 1) compare health disparities and patient outcomes of rural Latino older adult patients diagnosed with diabetes to their non-Latino White counterparts, and 2) ascertain the impact of ACO participation by rural primary care providers (along with other factors) on rural Latino older adult patients. The study has two goals: Aim 1: To measure the disparities in diabetes-related hospitalization rates between rural Latino older adult patients of Medicare ACOs and rural non-Latino White older adult patients, and Aim 2: To identify factors related to reduced disparities in diabetes-related hospitalization rates of rural Latino older adult patients, including RHC participation in a Medicare ACO. We will apply a pre-post design treating Medicare ACO participation as an intervention. The project will use data for a four-year period before the Medicare ACOs began (2008 - 2011) and a four-year period afterwards (2012 - 2015). The project will proceed in 3 major phases as follows: 1) collecting, merging, and organizing secondary data from multiple sources; 2) researching and constructing variables to include in the analyses; and 3) conducting univariate, bivariate, and multivariate analyses. The study will contribute to rural health research by adding to the knowledge about: 1) the factors that contribute to minimizing diabetes-related health disparities of rural Latino adults, 2) the diabetes preventive care effectiveness of ACOs, and 3) the types of ACOs most beneficial to rural Latino patients.