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，致力于研究解决慢性病患者在护理和结果方面的健康差距的策略。K01奖项将建立在先前培训和研究的坚实基础上，并通过一个由专家导师和顾问组成的多学科团队以及哈佛大学的杰出资源提供必要的高级教育和经验。在了解两个不同结构的大型健康计划中的组织程序、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)的倡议的采纳和可持续性方面，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提升已成为高度优先的研究领域。尽管人们越来越重视解决差异，但很少有实证研究表明，在减少弱势糖尿病人群的护理质量和结果方面的差异方面取得了可持续的成功。卫生系统在努力缩小差距方面的影响还没有得到很好的理解，特别是在管理保健组织中。拟议的研究将确定和探索可能影响差异的关键健康计划组织因素(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)；评估常用的绩效衡量标准如何很好地反映糖尿病患者在医疗保健质量和结果方面的潜在差异；以及评估提供者对基于系统的质量倡议的认识和响应可能如何影响患者管理方面的差异。通过采用混合方法理解实施全系统倡议的健康计划系统结构和流程的复杂性，这一研究方案可能会阐明为什么目前消除现有差距的努力未能实现其潜力。此外，这一计划将为Trinacty博士向健康差距领域的独立调查者过渡奠定基础，重点放在系统、提供者和减少糖尿病患者差距的倡议之间的联系上。

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.