Improving Minority Health by Monitoring Medicaid Quality, Disparities and Value

通过监测医疗补助质量、差异和价值来改善少数群体的健康

• 批准号: 10169888
• 负责人: Marcela V Horvitz-Lennon
• 金额: $ 19.72万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-20 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10169888
• 关键词: Address; Adherence; Administrative Supplement; Adopted; Adoption; Adult; Affect; Antipsychotic Agents; COVID-19; COVID-19 pandemic; Caring; Chronic; Continuity of Patient Care; Contracts; Country; Data; Data Sources; Development; Diabetes Mellitus; Disease Outbreaks; Effectiveness; Emergency Situation; Ethnic Origin; Funding; Future; General Practitioners; Geographic state; Guidelines; Health; Health Care Costs; Healthcare; High Prevalence; Individual; Interruption; Latino; Life; Life Expectancy; Measurement; Measures; Medicaid; Medical; Medical emergency; Mental Health; Mentally Ill Persons; Minority; Modeling; Monitor; Morbidity - disease rate; New York; Outcome; Parents; Patients; Persons; Play; Policies; Population; Population Heterogeneity; Positioning Attribute; Premature Mortality; Provider; Psyche structure; Psychiatric therapeutic procedure; Race; Readiness; Research; Research Personnel; Role; Schizophrenia; Series; Services; State Interests; Subgroup; Time; Visit; Vulnerable Populations; Work; acute care; beneficiary; burden of illness; care outcomes; cost; cost effectiveness; design; disability; disadvantaged population; effectiveness measure; ethnic minority population; evidence base; experience; health care availability; health care cost/financing; health care delivery; health care disparity; health disparity; high risk population; hospital readmission; improved; insight; interest; minority health; mortality; pandemic disease; physical conditioning; programs; psychiatric emergency; public health relevance; racial and ethnic; racial and ethnic disparities; response; severe mental illness; social disadvantage; study population; telehealth; tool

PROJECT SUMMARY Schizophrenia is a serious mental illness associated with a high burden of disease due to severe disability and premature mortality largely driven by co-occurring chronic medical conditions that shorten life expectancy by at least 20 years. The broad array of services needed by this population are primarily financed by Medicaid. Despite high costs, most patients do not receive recommended care, and minorities are less likely to do so than whites. These pre-existing disparities and the profound social disadvantage also experienced by this population make them particularly vulnerable to the devastation caused by the COVID-19 pandemic, which in the US has been particularly severe in the state of New York. New Yorkers with schizophrenia, and minorities in particular, are not only a high-risk group for poorer COVID-19 outcomes but they may also experience declines in their health due to disruptions in their ability to access healthcare. Although New York’s Medicaid program authorized the use of telehealth to mitigate those disruptions soon after the Governor declared a State of Emergency in early March 2020, the degree to which telehealth has been adopted by Medicaid providers serving seriously mentally ill people and whether the effects of telehealth adoption may vary by race/ethnicity are not well known. Our proposed administrative supplement application builds on our ongoing NIMHD-funded parent study (MD012428), which seeks to reduce healthcare disparities and thus improve health outcomes of racial/ethnic minority populations through measurement of quality disparities and value (or cost-effectiveness) of Medicaid-financed care delivered to adults with schizophrenia. Consistent with the NIMHD’s Notice of Special Interest calling for studies of the impact of the COVID-19 outbreak on health disparity populations, we propose to evaluate the effects of the outbreak on the racially/ethnically diverse population of Medicaid beneficiaries with schizophrenia living in New York. In Aim 1, we will assess the effect of the outbreak on racial/ethnic disparities in access, quality, and effectiveness of mental and physical healthcare delivered to our study population. In Aim 2, we will assess Medicaid providers’ responses to the outbreak and their effects on healthcare disparities in our study population. We will characterize provider response through a measure of provider readiness to adopt telehealth. Our general approach to assessing the impact of the outbreak on healthcare outcomes and the impact of provider responses on those outcomes will involve the use of post-pre outbreak differences, interrupted time series approaches, as well as approaches that utilize time-varying coefficients. In all analyses, our primary interest are parameters that describe how race/ethnicity moderates the outbreak’s effect on outcomes and the providers’ responses on outcomes. We expect that our work will provide policymakers with a better understanding of the impacts of the outbreak on vulnerable populations and enable the design of more effective policies to address this and future crises.

项目摘要 精神分裂症是一种严重的精神疾病，由于严重残疾， 过早死亡主要是由同时发生的慢性疾病造成的，这些疾病使预期寿命缩短 至少20年这一人群所需的各种服务主要由医疗补助提供资金。 尽管费用高昂，但大多数患者并没有得到推荐的护理，少数人也不太可能这样做 比白人。这些预先存在的差距和深刻的社会劣势也经历了这一点， 人口众多使他们特别容易受到COVID-19大流行造成的破坏， 美国在纽约州的情况尤为严重。患有精神分裂症的纽约人， 特别是，不仅是COVID-19结果较差的高风险群体，而且他们还可能经历 由于他们获得医疗保健的能力受到干扰，他们的健康状况下降。虽然纽约的医疗补助 在州长宣布一个州成立后不久，一项计划授权使用远程医疗来减轻这些中断 在2020年3月初，医疗补助提供者采用远程医疗的程度 为严重精神病患者提供服务，以及采用远程医疗的影响是否因种族/民族而异 并不广为人知。我们提出的行政补充申请建立在我们正在进行的NIMHD资助的 母研究（MD 012428），旨在减少医疗保健差异，从而改善 通过衡量质量差距和价值（或成本效益）， 由医疗补助资助的对成年精神分裂症患者的治疗。与NIMHD的通知一致， 特别关注呼吁研究COVID-19疫情对健康差距人群的影响，我们 建议评估疫情对医疗补助计划的种族/民族多样化人群的影响 受益人患有精神分裂症住在纽约。在目标1中，我们将评估疫情对 种族/民族差异的获取，质量和精神和身体保健的有效性提供给我们 研究人群。在目标2中，我们将评估医疗补助提供者对疫情的反应及其对 我们研究人群中的医疗保健差异。我们将通过以下措施来描述供应商的响应： 提供者准备采用远程保健。我们评估疫情影响的一般方法 医疗保健结果和提供者的反应对这些结果的影响将涉及使用后前 爆发差异、中断时间序列方法以及利用时变方法的方法 系数在所有分析中，我们的主要兴趣是描述种族/民族如何调节 疫情对结果的影响以及提供者对结果的反应。我们希望我们的工作将提供 决策者更好地了解疫情对弱势群体的影响， 制定更有效的政策来应对当前和未来的危机。

项目成果

Healthcare Access for a Diverse Population with Schizophrenia Following the Onset of the COVID-19 Pandemic.

• DOI: 10.1007/s10597-023-01105-1
• 发表时间: 2024-01
• 期刊: COMMUNITY MENTAL HEALTH JOURNAL
• 影响因子: 2.7
• 作者: Horvitz-Lennon, Marcela;Leckman-Westin, Emily;Finnerty, Molly;Jeong, Junghye;Tsuei, Jeannette;Zelevinsky, Katya;Chen, Qingxian;Normand, Sharon-Lise T.
• 通讯作者: Normand, Sharon-Lise T.