Economics of Racial & Ethnic Disparities in MH Services

描述(由申请人提供)：在医疗保健中产生种族/民族差异的机制在两个层面上运作：医疗保健系统和临床相遇。这项申请建议对导致精神卫生服务中种族/民族差异的机制进行研究。在申请中正式定义的差异，本质上是各群体之间卫生保健服务使用率的不合理差异。最近的理论和概念研究为实证分析差异背后的原因提供了框架。该应用程序建议应用和测试这些框架，以便向政策提供有关消除差距的有效行动的信息。我们聚集了一个多学科团队，利用之前收集的数据进行一系列综合的实证和政策研究。这项拟议的研究利用NIMH对大量种族和少数民族成员的数据进行投资，以在理解和减少精神卫生保健差异方面取得进展。应用程序的具体目标是：在比较少数群体和多数群体的精神卫生保健时，使用大型国家数据集来区分差异、差异和歧视，从而使最近提出的医学研究所关于差异的定义具有可操作性。量化精神健康方面的差距，并确定体制因素和歧视在精神健康服务差距中的作用。将非洲裔美国人、亚裔美国人和拉美裔美国人使用精神卫生保健的情况与白人的使用情况进行比较。使用抑郁症质量改善(QID)项目的数据，调查提供者方解释临床遭遇中歧视的机制。测试“统计歧视”是否可以解释非洲裔美国人和拉美裔美国人的诊断和治疗建议中的一些种族/民族差异。测试是否有证据表明，患者对提供者歧视的反应会导致这些少数民族的遵从率更低，结果更糟。

DESCRIPTION (provided by applicant): The mechanisms that generate racial/ethnic disparities in health care operate at two levels: the healthcare system, and the clinical encounter. This application proposes to conduct research on the mechanisms that lead to racial/ethnic disparities in mental health services. Disparities, defined formally in the application, are essentially unjustified differences in the rates of use of health care services across groups. Recent theoretical and conceptual research provides the frameworks for empirical analyses of the reasons behind disparities. This application proposes to apply and test these frameworks for the purposes of informing policy about effective actions to combat disparities. We bring together a multidisciplinary team to conduct a series of integrated empirical and policy studies using previously collected data. The proposed research capitalizes on NIMH investments in data with large numbers of members of racial and ethnic minorities to make progress on understanding and reducing mental health care disparities. The specific aims of the application are: Operationalize the recently proposed Institute of Medicine definition of disparities using a large national data set to distinguish among Differences, Disparities and Discrimination when comparing mental health care for minority and majority populations. Quantify disparities in mental health, and identify the role of system factors and discrimination in mental health services disparities. Compare mental health care use by African Americans, Asian Americans and Latinos with use by Whites. Investigate provider-side mechanisms explaining discrimination in the clinical encounter using data from the Quality Improvement for Depression (QID) projects. Test whether "statistical discrimination" can account for some of racial/ethnic differences in diagnosis and treatment recommendations for African-American and Latino populations. Test for evidence that patient reaction to provider discrimination leads to lower compliance rates and worse outcomes for these minorities.