BREAST CANCER OUTCOMES IN A DOUBLY DISADVANTAGED POPULATION: MEDICAID BENEFICIARI

描述（由申请人提供）：精神疾病（MI）患者，患有精神分裂症、双相情感障碍、重度抑郁症和/或药物滥用等疾病，也可能患有慢性疾病。然而，我们对他们使用非精神卫生服务的了解非常有限。心梗患者在获得和充分利用卫生服务方面面临许多障碍，包括（但不包括）经济障碍，以及理解和遵守医疗建议或治疗方面的困难。此外，由于精神疾病的优先管理，与非心肌梗死患者相比，心肌梗死患者对医疗状况的关注可能较少。因此，心肌梗死患者可能无法充分利用急需的保健服务，导致慢性疾病的预防和管理不力，发病率和死亡率高于非心肌梗死患者。癌症尤其如此，因为早期发现和接受适当的治疗和后续护理是癌症结局的一些最重要的决定因素。尽管在卫生服务利用模式和潜在结果方面存在这些重要差异，但在差异文献中，心肌梗死患者很少被确定为人口中的弱势亚群。拟议的研究将通过二次数据分析，描述俄亥俄州心肌梗死和非心肌梗死人群的乳腺癌筛查、诊断、治疗和监测模式。我们将重点关注女性乳腺癌，因为它的患病率很高，而且易于筛查。鉴于MI患者在医疗补助人群中的显著代表性，我们将使用与俄亥俄州癌症发病率监测系统（OCISS）相关的州医疗补助数据。首先，我们将比较有和没有心肌梗死的医疗保险参保妇女接受乳房x光检查的情况。接下来，在被诊断为偶发乳腺癌的妇女中，我们将确定心肌梗死是否与a)出现时的乳腺癌分期有关；B)早期乳腺癌患者接受明确的初级和辅助治疗；c)接受非转移性乳腺癌初始治疗后的指导监测。通过将我们的研究限制在医疗补助受益人中，我们将能够比较具有可比社会经济地位和各种其他类型障碍的心肌梗死和非心肌梗死患者之间的结果。拟议的研究将为更详细的评估铺平道路，旨在确定阻碍心肌梗死患者充分利用医疗服务的具体因素，并制定干预措施，以改善这一双重弱势患者群体的癌症预防和控制战略。此外，这些研究将提高卫生保健提供者和研究界对心肌梗死状态相关脆弱性的认识，以及在心肌梗死患者病例管理方案设计中特殊考虑的重要性。考虑到与医疗补助状态和精神疾病相关的脆弱性，患有精神疾病的医疗补助受益人代表了双重弱势群体，然而，与这一人群相关的研究在差异文献中缺失。通过比较有精神疾病和没有精神疾病的参保妇女的女性乳腺癌相关护理过程和结果措施，拟议的研究将为更详细的评估铺平道路，旨在确定阻碍心肌梗死患者充分利用医疗服务的具体因素，并制定干预措施，以改善这一患者群体的癌症预防和控制策略。

DESCRIPTION (provided by applicant): Individuals with mental illness (MI), suffering from such conditions as schizophrenia, bipolar disorder, major depression, and/or substance abuse, may also present with chronic medical conditions. Yet our understanding of their use of non-psychiatric health services is very limited. MI patients face numerous barriers to access and adequately utilize health services, including - but not encompassing - financial barriers, and difficulties understanding and being compliant with medical recommendation or treatment. Additionally, given the priority assigned to the management of psychiatric conditions, medical conditions may receive lesser attention in MI than in non-MI patients. Consequently, MI patients are likely to under use much needed health services, resulting in poor prevention and management of chronic diseases and greater morbidity and mortality than that observed in non-MI patients. This is particularly true of cancer, because early detection and receipt of adequate treatment and follow-up care are some of the most important determinants of cancer outcomes. Despite these important differences in patterns of health services utilization, and potential outcomes, MI patients have seldom been identified as a vulnerable subgroup of the population in the disparities literature. The proposed studies will describe patterns of breast cancer screening, diagnosis, treatment, and surveillance in MI and non-MI populations in Ohio, through secondary data analysis. We will focus on female breast cancer because of its high prevalence, and its amenability to screening. Given the significant representation of MI patients in the Medicaid population, we will be using state Medicaid data linked with the Ohio Cancer Incidence Surveillance System (OCISS). First, we will compare receipt of mammography by Medicaid-insured women between those with and without MI. Next, among those diagnosed with incident breast cancer, we will determine whether MI is associated with a) breast cancer stage at presentation; b) receipt of definitive primary and adjuvant treatment in early breast cancer patients; and c) receipt of guideline surveillance after initial treatment for non-metastatic breast cancer. By limiting our studies to Medicaid beneficiaries, we will be able to compare outcomes between MI and non-MI patients who share comparable socio-economic status and various other types of barriers in accessing care. The proposed studies will pave the way for more detailed evaluations aimed at identifying specific factors hindering adequate use of medical services by MI patients, and at developing interventions to improve strategies of cancer prevention and control in this doubly disadvantaged patient population. As well, these studies will raise awareness in the health care provider and research communities relative to the vulnerabilities associated with MI status, and the importance of special considerations in the design of case management programs for MI patients. Medicaid beneficiaries with mental illness represent a doubly disadvantaged population, given the vulnerabilities associated with each of Medicaid status and mental illness, yet studies relevant to this population have been absent from the disparities literature. By comparing female breast cancer-related care process and outcome measures among Medicaid-insured women between those with and without mental illness, the proposed studies will pave the way for more detailed evaluations aimed at identifying specific factors hindering adequate use of medical services by MI patients, and at developing interventions to improve strategies of cancer prevention and control in this patient population.