Ambulatory Care Access and Quality

描述（由申请人提供）：虽然许多研究指出在健康和医疗保健方面存在种族/民族、经济和教育相关的差异，但对残疾人知之甚少，这是最近被疾病预防控制中心认定为高危人口群体的人群。在这个广泛修订的应用程序中，我们建议从经验上显示每种获取、协调和护理质量对“可避免”住院的概率、时间和数量的影响程度，即继发于门诊护理敏感（ACS）条件的住院及其相关成本。具体来说，我们的目标是：(1)确定限制阶段影响的程度(i)获得医疗保健的障碍，（ii）护理协调和质量，（iii）实际接受符合指南的护理，（iv） ACS住院率和（）ACS相关住院费用；(2)研究获取障碍、护理协调和质量与指南依从性护理的实际接收之间的关系，并评估这些关系是否因限制阶段而变化；(3)确定(i)获得护理的障碍，（ii）护理协调和质量，以及（iii）指南合规护理的实际接收与ACS住院和相关费用相关的程度；(4)执行政策模拟以估计旨在(i)减少获取障碍的计划的相对贡献；（二）改善协调和护理质量；（三）加强提供符合指南的护理，以减少与acs相关的住院治疗和相关费用。这些目标将通过分析来自医疗保险当前受益人调查（MCBS）的纵向数据，在10年期间汇总。遵循直接标准化方法，我们将应用两阶段和竞争风险持续时间模型来估计捕获活动限制阶段、获取障碍、协调和感知护理质量以及指南依从性护理程度的措施对ACS住院和成本的独立影响。本研究除了提供残障人士照护差异潜在来源的机制资讯，以填补基本的知识空白外，还将提供一项创新的研究

DESCRIPTION (provided by applicant): While many studies point to racial/ethnic, economic, and education-related disparities in health and healthcare access, little is known about people with disabilities, a population recently recognized by the CDC as an at-risk demographic group. In this extensively revised application, we propose to show empirically the extent to which each access, coordination, and quality of care influence the probability, timing and number of "avoidable" hospitalizations, that is, hospitalizations secondary to Ambulatory Care Sensitive (ACS) conditions, and their related costs. Specifically, our aims are to: (1) determine the extent to which stages of limitation influence (i) access barriers to medical care, (ii) care coordination& quality, (iii) actual receipt of guideline compliant care, (iv) rates of ACS hospitalizations and () ACS-related hospitalization costs; (2) examine the relationship between access barriers, care coordination & quality, and actual receipt of guideline compliant care, and evaluate whether these relationships vary according to stages of limitation; (3) determine the extent to which (i) access barriers to care, (ii) care coordination & quality, and (iii) actual receipt of guideline compliant care are associated with ACS hospitalizations and related costs and (4) perform a policy simulation to estimate the relative contribution of programs aimed at (i) reducing access barriers, (ii) improving coordination & quality of care and (iii) enhancing provision of guideline compliant care in reducing ACS-related hospitalizations and associated costs. These aims will be carried out by analyzing longitudinal data from the Medicare Current Beneficiary Surveys (MCBS) aggregated over a 10-year period. Following direct standardization methods, we will apply two-stage and competing risk duration models to estimate the independent effects of measures capturing activity limitation stage, access barriers, coordination & perceived quality of care, and degree of guideline compliant care on ACS hospitalizations and costs. In addition to filling an essential knowledge gap by providing mechanistic information about potential sources of disparities in the care of persons with disabilities, this study will also provide an innovative policy simulation that will inform efforts to determine how best to allocate public resources in order to remediate disability disparities in avoidable hospitalizations and realize the greatest cost savings.