Implications of hospital-physician integration for urban-rural equity in access, care coordination, and outcomes.

项目总结 Brady Post博士的长期目标是解释系统级集成如何影响质量和公平，特别是 对农村居民来说。美国的医疗保健系统已经迅速走向更大程度的融合 医院和医生。作为组织医疗服务的一种方式，医院-医生一体化具有 在卫生政策界引起了很大争议。倡导者希望有更高的效率和更多的护理 协调，而怀疑者则对成本和质量提出担忧。这一紧迫的政策问题，有望成为 定义未来几十年的医疗保健问题，需要专注的学者。布雷迪·波斯特博士专注于他的 自从他在密歇根大学攻读博士学位以来，他就一直在这个主题上取得学术成就，并继续建立 在东北大学担任助理教授的证据库。他职业生涯的下一步自然是 用一套更复杂的方法推进医医结合的科学 这些方法将完善他的技能，同时有助于填补文献中持续存在的空白。 通过全面的培训计划，包括正式的课程和有指导的、基于项目的学习， 该项目将使波斯特博士具备(1)对农村卫生需求、政策和服务提供的深入了解(2) 定性和混合方法技术；(3)调查所需的调查设计和测量理论 研究。这一独特的组合将使波斯特博士能够指导医院-医生如何进行创新研究 一体化重塑了农村社区的医疗保健。这次培训将培养他作为一个独立人士的技能 研究人员，并为他成功竞争R01级拨款做好准备。该项目将检查这些影响 医院-医生一体化在护理协调、患者获得护理的机会以及健康方面的差异 在农村和城市地区取得的成果。它将利用丰富的调查数据来突出患者的观点和 使用深度访谈来突出医生和管理者的观点。有了这个奖项，波斯特博士将带来 医院-医生一体化文献的新概念和新方法 医疗保险和医疗补助服务中心、联邦贸易委员会和其他政策制定者 积极权衡加强一体化的利弊。这项建议直接回答了AHRQ的 要求进行保健服务研究以促进保健公平(NOT-HS-21-014)，并侧重于AHRQ 农村居民优先人口。该奖项将支持波斯特博士向独立的过渡，建立 他是一位研究日益一体化的医疗保健系统的质量和公平影响的知名学者。

PROJECT SUMMARY Dr. Brady Post’s long-term goal is to explain how system-level integration affects quality and equity, specifically for rural residents. The American health care system has moved quickly toward greater integration between hospitals and physicians. As a way to organize healthcare services, hospital-physician integration has generated much controversy within the health policy community. Advocates hope for more efficiency and care coordination while skeptics raise concerns over costs and quality. This pressing policy issue, poised to be a defining issue in health care for decades to come, requires dedicated scholars. Dr. Brady Post has focused his scholarship on this topic since his doctoral studies at the University of Michigan and he continues to build the evidence base as an Assistant Professor at Northeastern University. A natural next step in his career is to advance the science on hospital-physician integration using a more sophisticated set of methodological approaches that will round out his skillset and, simultaneously, help to fill persistent gaps in the literature. Through a comprehensive training plan that includes formal coursework and mentored, project-based learning, this project will equip Dr. Post with (1) deep knowledge of rural health needs, policy, and service delivery (2) qualitative and mixed-methods techniques, and (3) survey design and measurement theory needed for survey research. This unique combination will position Dr. Post to direct innovative studies of how hospital-physician integration reshapes health care in rural communities. This training will build his skills as an independent researcher and prepare him to successfully compete for R01-level grants. This project will examine the effects of hospital-physician integration on care coordination, patient access to care, and disparities in health outcomes across rural and urban areas. It will leverage rich survey data to highlight patients’ perspectives and use in-depth interviews to highlight physicians’ and mangers’ perspectives. With this award, Dr. Post will bring new concepts and new approaches to the literature on hospital-physician integration at a time when the Centers for Medicare and Medicaid Services, the Federal Trade Commission, and other policymakers are actively weighing the benefits and drawbacks of increased integration. This proposal directly answers AHRQ’s request for health services research to advance health equity (NOT-HS-21-014) and focuses on the AHRQ priority population of rural residents. This award will support Dr. Post’s transition to independence, establishing him as a leading scholar on the quality and equity implications of increasingly integrated health care systems.