Physician Referral & Mental-Disorder Related Disparities in CABG Quality

描述（由申请人提供）：患有共存精神障碍的内科或外科患者在获得适当的医疗保健方面面临重大障碍，特别是高质量的心脏服务。有证据表明，急性心肌梗死后，精神障碍患者倾向于使用侵入性心脏手术，包括冠状动脉旁路移植术（CABG）手术。此外，我们最近的工作表明，患有精神障碍（如精神疾病或药物滥用障碍）的患者在接受CABG手术时，更有可能接受护理质量较差的心脏外科医生的治疗。与精神障碍有关的心脏血管重建手术质量的差异是医疗保险人群特别关注的问题，因为超过25%的老年人患有精神障碍，冠心病是这一人群发病率和死亡率的主要原因之一。此外，每年有超过50%的CABG手术是在65岁及以上的人群中进行的。然而，相对知之甚少的动态基础上接受CABG手术的质量与共存的精神障碍，医学上的弱势群体，越来越多地被证明是遭受不适当的医疗和手术护理的患者的差异。该研究的目的是通过检查医生在将患者转诊至冠状动脉旁路移植术时的行为，帮助了解导致这些观察到的差异的原因以及相关的临床和政策影响。我们将分析医疗保险索赔数据，以检查实际的医生的做法，其中医生的行为，指冠心病患者与不精神障碍将进行比较。将采用多元统计回归分析。这项研究的结果将有助于设计未来的研究，旨在告知有效的政策和实践举措，以消除老年精神障碍患者所面临的差距，并更好地装备决策者，以解决在提供医疗服务的弱势，精神病患者的问题。 公共卫生相关性：本项目旨在研究转诊医生在冠心病患者接受高质量心脏手术的精神障碍相关差异中的作用。

DESCRIPTION (provided by applicant): Medical or surgical patients with coexisting mental disorders face significant barriers to accessing appropriate health care in general, and high quality cardiac services specifically. Evidence suggests that after acute myocardial infarction, patients with mental disorders tend to under-use invasive cardiac procedures including coronary artery bypass graft (CABG) surgery. In addition, our recent work shows that patients with mental disorders (such as psychiatric disorders or substance abuse disorders), when they do receive CABG surgery, are more likely to be treated by cardiac surgeons of inferior quality of care. The mental-disorder related disparities in quality of cardiac revascularization surgery are of particular concern for the Medicare population, as over 25% older persons are suffering mental disorders, and coronary heart disease (CHD) is one of the major causes of medical morbidity and mortality in this population. In addition, over 50% of all CABG surgeries are performed each year on individuals age 65 and over. However, relatively little is known about the dynamics underlying the disparity in quality of CABG surgery received by patients with coexisting mental disorders, a medically vulnerable group who has increasingly been shown to suffer from inappropriate medical and surgical care. The purpose of the study is to contribute to the understanding of the causes that lead to these observed disparities and the related clinical and policy implications, through an examination of physician behaviors in referring patients to CABG surgery. We will analyze Medicare claims data to examine actual physician practices, in which physician behavior in referring CHD patients with and without mental disorders will be compared. Multivariate statistical regression analyses will be employed. Findings of this study will help the design of future studies that aim to inform effective policy and practice initiatives to eliminate the disparities faced by elderly patients with mental disorders and better equip policy makers to address problems in the delivery of medical care to the vulnerable, mentally ill patients. PUBLIC HEALTH RELEVANCE: This proposed project was designed to examine the role of referring physicians in the mental-disorder related disparities in receipt of high-quality cardiac procedures among Medicare patients with coronary heart diseases.