Improving Native American Elder Access to and Use of Healthcare through Effective Health System Navigation

 描述(申请人提供)：过去二十年的重大公共保险改革，即那些要求参加管理保健计划的改革，未能实质性地满足美国印第安人的一般医疗需求，更不用说55岁及以上的美国印第安人的特殊需求，他们与美国所有其他老龄化人口相比，生活质量较差，预期寿命较低。美国印第安人老年人是美国医疗体系中被忽视的群体。尽管人们普遍认为印度医疗服务(IHS)将充分满足他们与健康相关的需求，但老年人受到保险缺口和无法获得医疗保健的负面影响。自2014年以来，《患者保护和平价医疗法案》(Patient Protection And Affordable Care Act)，加上州医疗补助计划的扩大，使得尚未有资格享受医疗保险的美国印第安人老年人有可能受益于医疗保险。《平价医疗法案》还旨在改善老年医疗保险中老年人获得服务的机会和服务质量，并包括改善美国印第安人医疗差距的特别条款。这项拟议的为期五年、以社区为导向的研究以混合方法、参与性研究设计为特色，旨在审查《平价医疗法案》下与保险相关的外展活动、寻求帮助的行为，以及新墨西哥州美国印第安人长老的医疗保健经历。新墨西哥州有22个联邦承认的普韦布洛斯人和部落。本研究结合了定性和定量访谈、概念图技术和焦点小组。收集到的信息将产生新的实用知识，基于美国印第安人长老和其他相关利益攸关方的实际视角，以改善在很大程度上被排除在国家和州医疗改革讨论之外的人群的医疗实践和政策。研究数据还将为文化定制方案的开发和评估提供信息，以增进美国印第安人长老对不断变化的医疗保健格局的理解和谈判。这项工作将填补公共保险倡议的研究空白，这些倡议通常不以AIE人群为重点，并将提供一个可复制的模式，以加强《平价医疗法案》对受医疗保健不平等影响的其他未得到充分服务的群体的影响。

 DESCRIPTION (provided by applicant): Major public insurance reforms of the past two decades, i.e., those requiring enrollment into managed care programs, have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older, who suffer from poorer quality of life and lower life expectancies compared to all other aging populations in the U.S. American Indian elders represent a neglected group within the nation's healthcare system. Despite the pervasive belief that the Indian Health Service (IHS) will fully address their health-related needs, elders are negatively affected by gaps in insurance and lack of access to healthcare. Since 2014, the Patient Protection and Affordable Care Act, plus state Medicaid expansion, has made it possible for American Indian elders who are not yet eligible for Medicare to benefit from healthcare coverage. The Affordable Care Act is also intended to improve access to and quality of services for seniors in Medicare and includes special provisions to ameliorate healthcare disparities for American Indians. This proposed five-year, community-driven study features a mixed-method, participatory research design to examine insurance-related outreach activities under the Affordable Care Act, help-seeking behavior, and the healthcare experiences of American Indian elders in New Mexico, home to 22 federally-recognized Pueblos and Tribes. This study combines qualitative and quantitative interviews with concept-mapping techniques and focus groups. The information gathered will generate new practical knowledge, grounded in the actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will also inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of healthcare by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on the AIE population, and will offer a replicable model for enhancing the effects of the Affordable Care Act on other underserved groups affected by inequities in healthcare.