Addressing Disparities in Bariatric Surgery outcomes for Medicaid Patients

项目摘要 严重肥胖(身体质量指数[BMI]&35)在美国影响着近2000万成年人，其发病率是美国的两倍 通常在成年人中来自最低的社会经济阶层，而不是最高的。患有严重肥胖的成年人 更有可能患有与肥胖相关的合并症，生活质量较差，寿命缩短。 随机对照试验和观察性研究发现，减肥手术提供了更大的 与医学相比，体重减轻和合并症解决，生活质量更好，寿命更长 体重管理策略。使用医疗补助状态作为识别较低社会经济地位(SES)的一种方式， 我们的初步数据表明，接受减肥手术的低SES患者的预后比 SES较高的患者。在2011-2014年间在威斯康星州接受减肥手术的所有成年人中，医疗补助计划 患者在第一年内急诊室就诊和再次住院率较高 减肥手术。同样，我们的单一机构对不同州的两个学术医疗中心进行了审查 发现医疗补助患者在手术后90天内急诊率和再次住院率较高。 在减肥手术后，医疗补助患者的体重减轻幅度也明显低于非医疗补助患者。 接受减肥手术的医疗补助和非医疗补助患者之间存在这些差异的原因是 未知。我们的长期目标是开发和实施有效的干预措施，以改善 严重肥胖的成年人。我们在此应用程序中的目标是识别患者和社区级别 与符合以下条件的医疗补助患者的90天和1年预后不佳相关的特征 接受减肥手术。为了实现这一点，我们将使用顺序解释性设计，其中包括 收集和分析定量数据，然后收集和分析定性数据。这是混合的 方法研究设计将允许我们通过额外的、 定性研究。我们提出了以下两个具体目标：1)确定患者特征和 社区层面的健康决定因素，与医疗补助和非最佳结果相关 医疗补助减肥手术患者；以及2)了解患者和临床护理团队对如何 影响医疗补助与非医疗补助结果的患者、提供者和社区层面的决定因素 接受减肥手术的医疗补助患者。

Project Abstract Severe obesity (body mass index [BMI]>35) affects nearly 20 million adults in the U.S. and is twice as common in adults from the lowest socioeconomic strata compared to the highest. Adults with severe obesity are much more likely to have obesity-related comorbidities, poorer quality of life, and shortened lifespans. Randomized controlled trials and observational studies have found that bariatric surgery provides greater weight loss and comorbidity resolution, better quality of life, and longer lifespans as compared with medical weight management strategies. Using Medicaid status as a way to identify lower socioeconomic status (SES), our preliminary data indicate that lower SES patients who undergo bariatric surgery have worse outcomes than higher SES patients. Among all adults who underwent bariatric surgery in Wisconsin from 2011-2014, Medicaid patients had higher rates of emergency department (ED) visits and readmissions within the first year following bariatric surgery. Similarly, our single institution reviews from two academic medical centers in different states found that Medicaid patients had higher rates of ED visits and readmissions within 90 days of surgery. Medicaid patients also lost significantly less weight than did non-Medicaid patients after bariatric surgery. Reasons for these disparities between Medicaid and non-Medicaid patients undergoing bariatric surgery are unknown. Our long-term goal is to develop and implement effective interventions that will improve the health of adults with severe obesity. Our objective in this application is to identify patient and community-level characteristics that are associated with suboptimal 90-day and 1-year outcomes for Medicaid patients who undergo bariatric surgery. To achieve this, we will use a sequential explanatory design, which includes collection and analysis of quantitative data, followed by collection and analysis of qualitative data. This mixed methods research design will allow us to explain and extend the quantitative findings through additional, qualitative studies. We propose the following two Specific Aims: 1) Identify patient characteristics and community-level determinants of health that are associated with suboptimal outcomes for Medicaid and non- Medicaid bariatric surgery patients; and 2) Understand patient and clinical care team perspectives on how patient, provider, and community-level determinants of health influence outcomes for Medicaid vs. non- Medicaid patients who undergo bariatric surgery.