Ambulatory Care Access and Quality

描述（由申请人提供）：虽然许多研究指出种族/民族，经济和教育相关的差异，在健康和医疗保健的访问，很少有人知道残疾人，最近被CDC确认为一个危险的人口群体。在这个广泛修订的应用程序中，我们建议以经验表明，在何种程度上每个访问，协调和护理质量的影响概率，时间和数量的“可避免的”住院，即住院继发于门诊护理敏感（ACS）条件，及其相关费用。具体而言，我们的目标是：（1）确定限制阶段影响（i）获得医疗保健的障碍，（ii）护理协调和质量，（iii）实际接受符合指南的护理，（iv）ACS住院率和（）ACS相关住院费用的程度;（2）检查获得障碍、护理协调和质量与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因限制阶段而异;（3）确定（i）获得护理的障碍，（ii）护理协调和质量，以及（iii）实际接受符合指南的护理与ACS住院和相关费用相关的程度，以及（4）执行政策模拟以估计旨在（i）减少获得障碍，（ii）改善护理的协调和质量;（iii）加强提供符合指南的护理，以减少ACS相关的住院和相关费用。这些目标将通过分析医疗保险当前受益调查（MCBS）在10年期间汇总的纵向数据来实现。在直接标准化方法之后，我们将应用两阶段和竞争风险持续时间模型来估计捕获活动限制阶段、获取障碍、协调和感知护理质量以及指南合规护理程度的措施对ACS住院和成本的独立影响。除了通过提供关于残疾人护理方面差异的潜在来源的机械信息来填补重要的知识空白外，这项研究还将提供一个创新的方法， 政策模拟将为确定如何最好地分配公共资源的努力提供信息，以纠正残疾人在可避免的住院治疗方面的差异，并实现最大的成本节约。

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.