Disparities in Diabetes Care: Health Plan Focus and Physician Responsiveness

描述（由申请人提供）：Connie Mah Trinacty博士，卫生服务研究员，致力于研究慢性病患者在护理和预后方面的健康差异策略。K01奖将建立在先前培训和研究的坚实基础上，并通过由专家导师和顾问组成的多学科团队以及哈佛大学的优秀资源提供必要的高级教育和经验。在了解两个大型、结构不同的健康计划中的组织流程、行动和结构如何影响解决糖尿病成员之间差异（即种族/民族、收入、教育）的举措的采用和可持续性方面，将获得宝贵的探索性研究经验。近年来，医疗保健差距和质量改进已成为高度优先的研究领域。尽管人们越来越关注解决差异，但很少有实证研究表明，在减少糖尿病易感人群的护理质量和结果差异方面取得了可持续的成功。卫生系统在努力减少差距方面的影响尚未得到很好的理解，特别是在管理式医疗组织中。拟议的研究将确定和探索可能影响差异的关键保健计划组织因素（例如，质量衡量过程、产品开发和营销战略、参与国家差异协作）；评估常用的绩效指标在多大程度上反映了糖尿病患者在卫生保健质量和结果方面的潜在差异；并评估提供者对基于系统的质量倡议的意识和响应如何影响患者管理的差异。通过混合方法来理解卫生计划系统结构和流程的复杂性，该研究项目可能会揭示为什么目前在消除现有差距方面的努力未能实现其潜力。此外，该计划将为Trinacty博士过渡到健康差异领域的独立研究者提供基础，重点关注系统，提供者和倡议之间的联系，以减少糖尿病患者的差异。

DESCRIPTION (provided by applicant): Connie Mah Trinacty, PhD, is a health services researcher committed to a research career investigating strategies to address health disparities in care and outcomes for chronically ill patients. A K01 award will build upon a strong foundation of prior training and research, and provide necessary advanced education and experience through a multidisciplinary team of expert mentors and advisors and the outstanding resources of Harvard University. Valuable exploratory research experience will be gained in learning how organizational processes, actions, and structure in two large, differently structured health plans influence the adoption and sustainability of initiatives to address disparities (i.e., race/ethnicity, income, education) among their diabetes members. In recent years, health care disparities and quality improvement have become high priority research areas. In spite of increasing attention on addressing disparities, few empirical studies demonstrate sustainable success in reducing disparities in quality of care and outcomes for vulnerable diabetes populations. The influence of health systems in efforts to reduce disparities is not well understood, particularly in managed care organizations. The proposed research will identify and explore key health plan organizational factors (e.g., quality measurement process, product development and marketing strategies, participation in national disparities collaboratives) that may affect disparities; assess how well commonly used performance measures reflect underlying disparities in health care quality and outcomes among diabetes patients; and evaluate how providers' awareness and responsiveness to systems-based quality initiatives may impact differences in patient management. Through a mixed-methods approach to understand the complexity of health plan system structures and processes by which system-wide initiatives are implemented, this research program may shed light on why current efforts in eliminating existing disparities fail to realize their potential. In addition, this program will provide the foundation for Dr. Trinacty's transition to an independent investigator in the field of health disparities, with a focus on the linkages between systems, providers, and initiatives to reduce disparities for diabetes patients.