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导航最困难。精神分裂症是一种慢性疾病，与严重的残疾有关，给社会带来了巨大的负担，在美国，少数族裔承担了更大比例的这种负担。尽管有一些证据表明精神分裂症的护理质量存在黑人和白人的差异，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。这项提案寻求使用来自四个种族/民族和地理不同的州的纵向数据来发现和了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贡献；(2)评估创新治疗的扩散速度的差异，并系统地估计县级因素对差异的贡献；(3)通过对AIM(1)中确定的高绩效和低绩效县的决策者和其他关键个人的详细访谈，调查与公平有关的政策。通过收集与差距相关的背景因素的证据，我们将提供改革的具体目标、资源分配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层面差异相关的背景因素。这种细致入微的知识对于旨在提高护理质量和公平性的公共政策努力非常有价值。

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.