Implementing the institute of medicine definition of disparities: An application to mental health care
Implementing the institute of medicine definition of disparities: An application to mental health care
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DOI：
10.1111/j.1475-6773.2006.00583.x
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发表时间：
2006-10-01
影响因子：
3.4
通讯作者：
Zaslavsky, Alan M.
中科院分区：
文献类型：
--
作者：
McGuire, Thomas G.;Alegria, Margarita;Zaslavsky, Alan M.
在最近的一份报告中，医学研究所(IOM)将人口群体之间的卫生服务差距定义为在治疗或获得方面的差异，而不是以群体的健康状况或偏好的差异为理由。社区卫生保健在1997-1998年间从社区跟踪研究中重新访问了9585名受访者，对有心理困扰、酗酒、药物滥用或精神健康治疗的个人进行了过度抽样。这项研究旨在对全国范围内的服务使用情况进行估算。使用广义线性模型对支出进行建模，其中对数量进行对数连接，对任何使用情况使用概率模型。我们通过将少数民族人口的健康状况的整个分布转化为近似的白人分布来调整健康状况的群体差异。根据国际移民组织的定义，我们将差异与其他通常用于评估医疗服务差异的方法进行比较。我们的方法发现白人、黑人和拉丁裔之间存在显著的服务差异。由于在国际移民组织的方法中纳入了中介因素(如收入)的影响，因此这种方法的估计差异超过了竞争方法的差异。需要对差异进行严格的定义，以监测差异的进展情况，并在研究中比较差异的大小。有了这样的定义，就可以通过对支出和获得心理健康服务的模型中的群体差异进行调整来估计差异。
In a recent report, the Institute of Medicine (IOM) defines a health service disparity between population groups to be the difference in treatment or access not justified by the differences in health status or preferences of the groups. This paper proposes an implementation of this definition, and applies it to disparities in outpatient mental health care.Health Care for Communities (HCC) reinterviewed 9,585 respondents from the Community Tracking Study in 1997-1998, oversampling individuals with psychological distress, alcohol abuse, drug abuse, or mental health treatment. The HCC is designed to make national estimates of service use.Expenditures are modeled using generalized linear models with a log link for quantity and a probit model for any utilization. We adjust for group differences in health status by transforming the entire distribution of health status for minority populations to approximate the white distribution. We compare disparities according to the IOM definition to other methods commonly used to assess health services disparities.Our method finds significant service disparities between whites and both blacks and Latinos. Estimated disparities from this method exceed those for competing approaches, because of the inclusion of effects of mediating factors (such as income) in the IOM approach.A rigorous definition of disparities is needed to monitor progress against disparities and to compare their magnitude across studies. With such a definition, disparities can be estimated by adjusting for group differences in models for expenditures and access to mental health services.