Urban-Rural Disparities in Healthcare Quality for Children with Complex or Disabling Health Conditions

项目摘要/摘要 美国共有1180万儿童生活在农村地区，其中四分之一的儿童 慢性健康状况。这一人群更有可能有残疾，不太可能接受预防性治疗 与居住在城市地区的儿童相比，儿童更有可能报告未得到满足的医疗保健需求。因此，他们 代表了健康结果差异的高风险的服务不足群体。患有复杂或复杂疾病的儿童 当他们生活在农村地区时，由于以下原因，致残的健康状况可能特别有可能产生不良后果 他们长期和多方面的医疗保健需求。然而，在人口层面上，我们对此知之甚少 城乡在获得医疗保健方面的差距如何影响这一弱势群体。这样做的总体目标是 建议综合评价城乡儿童卫生保健利用和质量差距 使用来自三个州的五年全额付款人索赔数据，对复杂或致残的健康状况： 科罗拉多州、马萨诸塞州和新罕布夏州。这些州代表着不同的人口 地理、乡村和种族/民族，使它们非常适合拟议的分析。我们将进行一项 对大约140,000名儿童进行了回溯性队列研究，以：(I)确定城乡差距 门诊、急诊和住院医疗保健利用情况；(2)城乡差距 保健质量，(三)确定与#年城乡差距有关的社区和保健系统因素 医疗质量，以及(Iv)在照顾这些儿童的医生之间建立患者共享网络，以 确定居住在农村和城市的儿童之间的患者共享网络有何不同，以及这些 差异与护理质量的差异有关。构建医患共享网络 -即，在共享的基础上开发的医生之间关系的结构化表示 患者--提供了一种系统的方法来识别存在于 正式的组织结构，这可能与生活在农村地区的儿童特别相关。在成人中 人口、网络特征与资源利用、实践模式和 医疗保健结果。然而，这项研究将第一次探索医生网络在 居住在城市和农村的儿童，表征了可以利用的可修改的卫生系统因素 今后努力缩小城乡在护理质量方面的差距。该项目将由一名 具有临床专业知识的多学科团队，为患有复杂医学疾病的儿童提供护理，以及 使用所有付款人索赔数据来评估医疗质量和构建社交网络的研究专业知识。 这项研究将产生必要的数据，为后续的实施和评估提供信息 采取干预措施，减少健康状况复杂或致残的农村儿童的健康差距。

PROJECT SUMMARY/ABSTRACT A total of 11.8 million children live in rural areas of the United States, and one-quarter of these children have chronic health conditions. This population is more likely to have disabilities, less likely to receive preventative care, and more likely to report unmet healthcare needs than children who live in urban areas. As such, they represent an underserved group at high risk for disparities in health outcomes. Children with complex or disabling health conditions may be at particular risk of adverse outcomes when they live in rural areas due to their chronic and multifaceted healthcare needs. However, at a population level we know extremely little about how urban-rural disparities in health care access impact this vulnerable population. The overall objective of this proposal is to comprehensively evaluate urban-rural disparities in health care utilization and quality for children with complex or disabling health conditions using five years of all-payer claims data from three states: Colorado, Massachusetts and New Hampshire. These states represent diverse populations with respect to geography, rurality, and race/ethnicity, making them ideally suited to the proposed analyses. We will conduct a retrospective cohort study of approximately 140,000 children to: (i) identify urban-rural disparities in ambulatory, emergency and inpatient healthcare utilization, (ii) characterize urban-rural disparities in healthcare quality, (iii) identify community and health-system factors associated with urban-rural disparities in healthcare quality, and (iv) construct patient-sharing networks among physicians who care for these children to determine how patient-sharing networks differ between rural- and urban-residing children, and whether these differences are associated with disparities in quality of care. Construction of physician patient-sharing networks – that is, structural representations of relationships between physicians developed on the basis of shared patients -– provides a systematic approach to identify relationships between physicians that exist outside of formal organizational structures, which may be particularly relevant to children living in rural areas. In adult populations, network characteristics have been associated with resource utilization, practice patterns, and healthcare outcomes. However, this study will be the first to explore how physician networks differ between urban- and rural-residing children, characterizing a modifiable health system factor that may be leveraged in future work to reduce urban-rural disparities in their quality of care. This project will be conducted by a multidisciplinary team with clinical expertise providing care for children with medical complexity, as well as research expertise using all-payer claims data to evaluate healthcare quality and construct social networks. This research will generate essential data to inform the subsequent implementation and evaluation of interventions to reduce health disparities for rural-residing children with complex or disabling health conditions.