Physician Referral & Mental-Disorder Related Disparities in CABG Quality

描述（由申请人提供）：患有并存精神障碍的内科或外科患者通常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包括冠状动脉旁路移植术（CABG）在内的有创心脏手术。此外，我们最近的工作表明，患有精神障碍（如精神障碍或药物滥用障碍）的患者，当他们接受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。由于超过25%的老年人患有精神疾病，而冠心病（CHD）是这一人群中医疗发病率和死亡率的主要原因之一，因此与精神疾病相关的心脏血管重建术质量差异对医疗保险人群尤为关注。此外，每年超过50%的冠状动脉搭桥手术是在65岁及以上的人群中进行的。然而，对于同时存在精神障碍的患者所接受的冠脉搭桥手术质量差异背后的动态，人们知之甚少，这是一个医学上的弱势群体，越来越多的证据表明，他们遭受了不适当的医疗和手术护理。本研究的目的是通过检查医生在转诊患者进行冠脉搭桥手术时的行为，有助于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意义。我们将分析医疗保险索赔数据来检查实际的医生实践，其中医生在转诊伴有和不伴有精神障碍的冠心病患者时的行为将进行比较。采用多元统计回归分析。本研究的结果将有助于未来研究的设计，旨在为有效的政策和实践举措提供信息，以消除老年精神障碍患者面临的差距，并使政策制定者更好地解决向弱势精神疾病患者提供医疗服务的问题。

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.