Disparities in Diabetes Care: Health Plan Focus and Physician Responsiveness

描述（由申请人提供）：Connie Mah Trinacty博士是一名卫生服务研究员，致力于研究解决慢性病患者护理和结果中健康差异的策略。K 01奖将建立在先前培训和研究的坚实基础上，并通过多学科专家导师和顾问团队以及哈佛大学的优秀资源提供必要的先进教育和经验。将获得宝贵的探索性研究经验，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差异的举措的采用和可持续性（即，种族/民族、收入、教育）。近年来，卫生保健差距和质量改善已成为高度优先的研究领域。尽管越来越多的关注解决差距，很少有实证研究表明，可持续的成功，减少差异的护理质量和结果的脆弱糖尿病人群。卫生系统在努力减少不平等方面的影响还没有得到很好的理解，特别是在管理式护理组织中。拟议的研究将确定和探索关键的健康计划组织因素（例如，质量测量过程、产品开发和营销策略、参与国家差异（例如，医疗质量和医疗服务质量）;评估可能影响差异的绩效指标（例如，医疗质量和医疗服务合作伙伴）;评估常用的绩效指标如何反映糖尿病患者医疗质量和结局的潜在差异;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。通过混合方法的方法来了解的复杂性，卫生计划系统的结构和过程，全系统的举措实施，这项研究计划可能会揭示为什么目前的努力，消除现有的差距未能实现其潜力。此外，该计划将为Trinacty博士过渡到健康差异领域的独立调查员提供基础，重点是系统，供应商和举措之间的联系，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.