Race and Medicare-Medicaid Dual Enrollment Disparities in Access to Quality and Intensity of Post-Acute Rehabilitation Care and Health Outcomes in Patients with Stroke

项目总结 中风相关护理中的种族差异仍然是美国最令人关注的医疗服务问题之一 各州。中风患者约占所有住院康复机构(IRF)入院人数的20%。然而， 到目前为止，探索以患者为中心的结果与患者的质量和强度相关的研究有限 以IRF为基础的中风患者的康复服务，这些患者是种族/民族少数民族，具有双重资格 医疗保险和医疗补助。我们的建议使用综合混合方法设计来研究个体-和 提供者层面的因素导致了IRF质量评级和治疗量的差异，随后， 两者对患者健康结局的联合影响。定性目标将确定促进者和障碍 卒中后少数族裔和具有双重资质的人的IRF选择及其影响 根据患者对IRF护理质量的感知来选择高质量的IRF。 这项研究将使用100%的医疗保险索赔和评估数据(2017-2022年)，并从 了解来自不同地区的患者/护理人员、医院出院规划者和康复临床医生 IRF的选择过程和结果。我们将利用医疗保险住院患者标准分析文件， 受益人摘要，住院康复机构患者评估工具，服务提供者，以及 公开可用的IRF Medicare比较数据。“指标性卒中”患者从急性期直接入院 医院将成为我们的主要队列。对于前三个目标，a)职能状态的改变，b)30天 再次住院，以及c)社区出院将作为主要结果，根据患者-- 医院级、市场级的特点。对于第四个定性目标，患者对IRF质量和 感觉到的功能恢复将是评估差异的影响的主要依赖变量 康复护理。

PROJECT SUMMARY Racial disparity in stroke-related care remains among the most compelling health service concerns in the United States. Stroke patients account for about 20% of all inpatient rehabilitation facility (IRF) admissions. However, there is limited research to date exploring patient-centered outcomes associated with the quality and intensity of IRF-based rehabilitation services among stroke patients who are racial/ethnic minorities and are dual eligible for Medicare and Medicaid. Our proposal uses an integrative mixed methods design to study how individual- and provider-level factors contribute to disparities in IRF quality rating and amount of therapy, and subsequently, the combined effect of the two on patient health outcomes. The qualitative aim will identify facilitators and barriers to IRF selection among racial/ethnic minorities and those with dual eligiblility after stroke and the impact of the selection of quality IRFs on patient perceptions of IRF quality of care. This study will use 100% Medicare claims and assessment data (2017-2022), and perspectives from patients/caregivers, hospital discharge planners, and rehabilitation clinicians from different regions to understand selection processes of IRF and outcomes. We will utilize the Medicare Inpatient Standard Analytical File, Beneficiary Summary, Inpatient Rehabilitation Facilities Patient Assessment Instrument, Provider of Service, and publicly available IRF Medicare compare data. Patients with ‘index stroke’ admitted directly to IRFs from acute hospitals will serve as our primary cohort. For the first three aims, a) change in functional status, b) 30-day hospital readmission, and c) community discharge will serve as primary outcomes, adjusting for patient-, hospital-, and market-level characteristics. For the fourth, qualitative aim, patient perception of IRF quality and perceived functional recovery will be primary dependent variables for assessing the impact of disparities in rehabilitation care.