An In-Depth Investigation of Racial & Ethnic Disparities in Schizophrenia Care

对种族的深入调查

• 批准号: 8139114
• 负责人: Marcela V Horvitz-Lennon
• 金额: $ 39.75万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-08 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8139114
• 关键词: Accounting; Address; Attention; Caring; Characteristics; Chronic; Communities; Complement; County; Data; Diffusion; Diffusion of Innovation; Goals; Health Care Costs; Health Status; Healthcare; Healthcare Systems; Individual; Intervention; Interview; Investigation; Knowledge; Latino; Life; Medicaid; Minority; Outcome; Patients; Pattern; Patterns of Care; Persons; Policies; Policy Maker; Process; Public Policy; Quality of Care; Research; Resource Allocation; Role; Schizophrenia; Services; Societies; Time; United States; Variant; Work; base; beneficiary; clinical practice; comparative; contextual factors; disability; geographic difference; improved; innovation; novel; preference; programs; public health relevance; racial and ethnic; racial and ethnic disparities; severe mental illness; trend

DESCRIPTION (provided by applicant): Understanding disparities for those with severe mental illness, particularly those with schizophrenia, is essential as these individuals have the most difficulty navigating the U.S. health care system. Schizophrenia is chronic, associated with substantial disability, and poses a large burden to society, with minorities bearing a larger share of this burden in the U.S. Although there is some evidence of black-white disparities in quality of schizophrenia care, little research is available for Latinos or about temporal trends. We do not know whether geographic variation in patterns of care contribute to disparities; nor do we know the role of characteristics of the communities where patients live in disparities. This proposal seeks to detect and understand disparities for black and Latino Medicaid beneficiaries with schizophrenia using longitudinal data from four racially/ethnically and geographically diverse states. We aim to (1) assess disparities in quality of care and to systematically estimate the contribution of county-level factors to disparities; (2) assess disparities in diffusion rates of innovative treatments and to systematically estimate the contribution of county-level factors to disparities; and (3) investigate policies associated with equity through detailed interviews with policy-makers and other key individuals based at high- and low-performing counties identified in Aim (1). By gathering evidence of the contextual factors associated with disparities, we will provide concrete targets for reform, priorities for resource allocation, and policy levers in the service of equity. PUBLIC HEALTH RELEVANCE: The proposed research has public health relevance because in addition to documenting the existence of health care disparities for publicly insured people with schizophrenia we seek to elucidate contextual factors associated with disparities at the local level. This kind of granular knowledge can be extremely valuable to public policy efforts aimed at improving quality and equity of care.

描述（由申请人提供）：了解严重精神疾病患者（尤其是精神分裂症患者）的差异至关重要，因为这些人在美国医疗保健系统中最困难。精神分裂症是慢性的，与严重残疾相关，给社会带来巨大负担，在美国，少数族裔承担了更大的负担。尽管有一些证据表明黑人和白人在精神分裂症护理质量方面存在差异，但针对拉丁裔或关于时间趋势的研究很少。我们不知道护理模式的地理差异是否会造成差异；我们也不知道患者所居住的社区特征的差异所起的作用。该提案旨在利用来自四个种族/民族和地理不同州的纵向数据来发现和理解患有精神分裂症的黑人和拉丁裔医疗补助受益人的差异。我们的目标是 (1) 评估护理质量的差异，并系统地估计县级因素对差异的影响； (2) 评估创新疗法推广率的差异，并系统估计县级因素对差异的影响； (3) 通过对目标 (1) 中确定的高绩效和低绩效县的政策制定者和其他关键人物进行详细访谈，调查与公平相关的政策。通过收集与差异相关的背景因素的证据，我们将提供具体的改革目标、资源配置的优先事项以及服务于公平的政策杠杆。 公共卫生相关性：拟议的研究具有公共卫生相关性，因为除了记录公共保险精神分裂症患者存在的医疗保健差异外，我们还试图阐明与地方一级差异相关的背景因素。这种细致的知识对于旨在提高护理质量和公平性的公共政策工作非常有价值。