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1/2-Building Infrastructure for Community Capacity in Accelerating Integrated Care

1/2-为加速综合护理的社区能力建设基础设施

基本信息

批准号：
10333212
负责人：
MARGARITA ALEGRIA
金额：
$ 99.66万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10333212
关键词：
Address Adoption Affordable Care Act Automobile Driving Caring Case Manager Characteristics Chinese Client Clinic Communities Community Health Aides Development Elements Evidence based intervention Face Fee-for-Service Plans Goals Health Health Personnel Healthcare Home Human Resources Immigration Individual Infrastructure Insurance Carriers International Intervention Language Linguistics Link Low income Maintenance Massachusetts Measures Mediator of activation protein Medicaid Medicaid eligibility Mental Health Mental Health Services Minority Minority Groups Modeling North Carolina Outcome Participant Patient-Centered Care Patients Performance Personal Satisfaction Physicians Population Provider Quality of Care Research Resource-limited setting Resources Risk Behaviors Role Services Site Social Work System Testing Training Work anxiety symptoms barrier to care base bilingualism care coordination care delivery care systems collaborative care community based service community engagement community partnership community setting computerized contextual factors cultural competence depressive symptoms disparity reduction effectiveness testing eligible participant ethnic minority evidence base experience health care delivery health literacy implementation evaluation implementation outcomes implementation process improved improved functioning innovation intervention effect intervention program low and middle-income countries low income country member minority disparity multidisciplinary patient population physical conditioning population based population health primary care services provider networks racial and ethnic racial health disparity service providers social training opportunity

项目摘要

PROJECT SUMMARY Although individuals from racial/ethnic and linguistic minority groups make up a considerable—and growing— proportion of the US population, they experience greater unmet need for mental health care than non-Latino Whites. Members of these groups are heavily represented in Medicaid, the largest insurer covering the most vulnerable individuals. And although the Affordable Care Act expanded Medicaid eligibility, research to date has not found that expansions have decreased the gap in mental health treatment between Whites and racial/ethnic minorities. Experts have identified a lack of culturally competent, bilingual/bicultural mental health providers as a factor contributing to the maintenance of these disparities. Similar challenges have been addressed in lower-income countries facing severe workforce constraints through the training of community health workers (CHWs), who originate from the communities they serve and have shown promise internationally as mental health service providers. However, they have not yet typically served in this role in US care delivery systems. State Medicaid-based accountable care organizations (ACOs) are forming in large numbers to provide care coordination via team-based approaches, with accumulating evidence suggesting that this strategy can greatly benefit resource-poor populations. However, many ACOs have not yet incorporated mental health services into their networks, despite the observed link between addressing mental health needs and improving physical health. Building staff capacity to provide these needed services would help ACOs implement evidence-based mental health interventions and improve the overall well-being of their assigned patients. Thus, our proposed collaborative R01 will develop ACO-academic-community partnerships in two demographically different states at different stages of ACO development and test a model that trains CHWs to serve as mental health providers within clinics/physician's organization and community-based organizations linked to ACOs in North Carolina and Massachusetts. This effort should expand ACO infrastructures and increase access to and quality of mental health care for low-income racial/ethnic and linguistic minorities in resource-poor communities. If successful, we will work with our ACO site partners to assess implementation outcomes of adoption, fidelity, maintenance, and explore implementation processes (facilitators and contextual factors) as potential mediators of implementation within diverse clinics, CBOs, and ACO networks.

项目总结