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

描述（由申请人提供）：了解严重精神疾病患者，特别是精神分裂症患者的差异是至关重要的，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，与严重的残疾有关，给社会带来了很大的负担，在美国，少数民族承担了更大的负担。尽管有一些证据表明黑人和白人在精神分裂症治疗质量上存在差异，但很少有关于拉丁美洲人或时间趋势的研究。我们不知道护理模式的地理差异是否会导致差异；我们也不知道患者生活在差异中的社区的特征所起的作用。本提案旨在利用来自四个种族/民族和地理上不同的州的纵向数据来检测和理解黑人和拉丁裔医疗补助受益人的精神分裂症差异。我们的目标是(1)评估医疗质量的差异，并系统地估计县级因素对差异的贡献；(2)评估创新疗法传播率的差异，并系统评估县级因素对差异的贡献；(3)通过对目标(1)中确定的高绩效和低绩效国家的政策制定者和其他关键人物的详细访谈，调查与公平相关的政策。通过收集与差距相关的背景因素的证据，我们将提出具体的改革目标、资源配置重点和促进公平的政策杠杆。

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.