Evaluating Behaviors that Build and Maintain Relationships between Patients and their Physicians

项目总结/摘要 本申请要求行政补充，以延长芝加哥大学中心的工作， 健康老龄化行为和纵向调查（CHABLIS）。CHABLIS支持研究和 基础设施开发，利用来自观察性和干预性研究的纵向数据， 人口和经济因素如何影响老年人的健康老龄化行为和结果。本申请 重点研究可能影响患者之间护理连续性的两种行为，这些患者的风险增加 住院和他们的医生。这一重点的动机是有证据表明，更大的连续性护理可以改善 住院风险增加的患者的结局。这些证据包括我们的综合研究 护理计划（CCP）发现，为同一名医生提供住院治疗风险增加的患者， 可以减少住院和改善健康结果。这些研究表明， 病人的行为可能会减少这些潜在的好处，特别是对那些社会需求未得到满足的病人。第一，患者 可能没有充分意识到护理连续性的机会，因为他们没有参与门诊护理， CCP供应商。其次，患者在保险范围方面的行为（或不行为）可能导致患者 由于Medicare管理式照护中有限的提供者网络可能无法 照顾他们的CCP。这项研究涉及定量和定性方法，将是第一个研究 行为，包括参与门诊护理和维持传统的Medicare或网络内Medicare 管理式医疗保险，这影响了CCP护理的整体患者参与度。它还将研究 综合护理社区和文化计划（C4 P）旨在提高患者对CCP的参与度 护理影响这些影响患者-提供者连续性的行为。虽然专注于CCP，但我们期待 关系连续性的驱动因素也与高风险患者的其他干预措施有关。 我们提出了4个具体目标来研究可能影响他们参与CCP护理的患者行为： 目的1：评估以下因素对参与CCP护理的影响：1） 患者可获得CCP护理，以及2）取代传统医疗保险或网络内医疗保险管理 提供CCP护理的医疗保险管理式医疗保险，不提供 获得CCP护理。我们将在CCP研究的CCP组和C4 P研究的CCP组中对此进行评估。 目的2：评估预测因素，包括双重合格状态、住院史和未满足的社会需求模式。 需要，这些形式的减少参与CCP。我们将在CCP研究的CCP分支中评估这一点， C4 P研究的CCP组。 目的3：评估C4 P计划如何影响患者参与CCP护理。 目的4：通过对患者访谈的定性分析，评估患者参与CCP/C4 P的驱动因素。

Project Summary/Abstract This application requests an administrative supplement to extend the work of the University of Chicago Center for Healthy Aging Behaviors and Longitudinal InvestigationS (CHABLIS). CHABLIS supports research and infrastructure development that leverages longitudinal data from observational and interventional studies to study how demographic and economic factors affect healthy aging behaviors and outcomes in older adults. This application focuses on studying two behaviors that can affect continuity of care between patients at increased risk of hospitalization and their physicians. This focus is motivated by evidence that greater continuity of care can improve outcomes for patients at increased risk of hospitalization. This evidence includes studies of our Comprehensive Care Program (CCP) that find that providing patients at increased risk of hospitalization care from the same doctor in and out of the hospital can reduce hospitalization and improve health outcomes. These studies suggest that two key patient behaviors may reduce these potential benefits, especially for patients with unmet social needs. First, patients may not fully realize the opportunities for continuity of care because they do not engage in ambulatory carewiththeir CCPproviders. Second, patient actions (or inactions) with respect to insurance coverage can cause patients to lose coverage for care from their CCP care because limited provider networks in Medicare managed care may not cover care from their CCP. This study, involving quantitative and qualitative methods, would be the first to examine behaviors, including engagement in ambulatory care and maintaining traditional Medicare or in-network Medicare managed care coverage, that affect overall patient engagement in CCP care. It will also study whether the Comprehensive Care Community and Culture Program (C4P) designed to increase patient engagement in CCP care affects these behaviors that affect patient-provider continuity. Though focused in CCP, we expect the insights into drivers of relational continuity are also relevant to other interventions for high-risk patients. We propose 4 specific aims to study patient behaviors that may affect their engagement in CCP care: Aim 1: To assess the effects on engagement in CCP care of 1) reduced engagement in CCP ambulatory care in patients with access to CCP care, and 2) replacement of traditional Medicare or in-network Medicare managed care coverage that provides access to CCP care by Medicare managed care coverage that does not provide access to CCP care. We will assess this in the CCP arm of the CCP study and the CCP arm of the C4P study. Aim 2: To assess predictors, including dual eligible status, hospitalization history, and patterns of unmet social needs, of those forms of reduced engagement in CCP. We will assess this in the CCP arm of the CCP study and the CCP arm of the C4P study. Aim 3: To assess how the C4P program affects patient engagement in CCP care. Aim 4: To assess drivers of patient engagement in CCP/C4P through qualitative analysis of patient interviews.