Understanding Disparities in Preventive Services for Patients with Mental Illness

描述（由申请人提供）：患有严重精神疾病（SMI）的人——精神分裂症谱系障碍、双相情感障碍——的预期寿命比没有严重精神疾病的人短约25年。这种早期死亡主要是由于可预防的慢性疾病，包括那些由重度精神分裂症处方药物的代谢副作用引起或恶化的疾病。除了罹患危及生命的慢性疾病的风险增加外，重度精神障碍患者比非重度精神障碍患者更不可能接受符合指南的预防保健。然而，对于重度精神障碍患者使用预防保健服务的总体模式，以及患者、临床医生、组织或监管层面影响预防服务吸收的可改变因素，我们所知甚少。提出了解决重度精神分裂症患者健康差异的新举措，包括在精神病诊所内建立医疗所，并将医疗和精神病护理结合起来；然而，由于缺乏评估产生这些差异的潜在因素的研究，尚不清楚这些策略是否代表最佳方法。我们提出了一项为期5年的混合方法研究，以检查可改变的监管、组织、提供者、提供者-患者和患者层面因素在严重精神疾病患者预防服务使用差异中的作用。我们使用来自大型非营利综合健康计划和同样大的安全网诊所网络的电子医疗记录数据来检查大约65,000名重度精神障碍患者（18岁及以上）的预防服务使用情况，并将他们与年龄相近的非重度精神障碍患者（约70万）进行比较，以确定患者、提供者、组织和监管机构对预防服务使用的预测因素。我们还将与患者和提供者进行少量的形成性半结构化访谈，以开发临床医生调查和患者访谈材料（结构化和半结构化）。来自临床医生调查的信息将用于预测小组级别的预防服务使用情况。与患者的半结构化访谈将用于确定影响寻求预防服务意愿的因素，以及寻求此类服务的障碍和促进因素。

DESCRIPTION (provided by applicant): The life expectancy of people with serious mental illness (SMI)-schizophrenia spectrum disorders, bipolar disorders-is about 25 years shorter than that those without SMI. This early mortality is due largely to preventable chronic conditions, including those caused or worsened by the metabolic side effects of medications prescribed for SMI. In addition to being at increased risk for life-threatening chronic conditions, patients with SMI may be less likely than those without SMI to receive the guideline-concordant preventive care for these disorders. Little is known, however, about overall patterns of preventive care service use among patients with SMI, or about modifiable factors at the patient, clinician, organizational, or regulatory level that affect uptake of preventive services. New initiatives to address health disparities experienced by individuals with SMI have been proposed, including creating medical care homes within psychiatric clinics and integrating medical and psychiatric care; yet it is unclear if such strategies represent the best approaches, given the dearth of research assessing the underlying factors that produce these disparities. We propose a 5-year, mixed methods study to examine the role of modifiable regulatory-, organizational-, provider-, provider-patient-, and patient-level factors contributing to disparities in preventive service use among patients with serious mental illness. We use electronic medical record data from a large non-profit integrated health plan and an equally large network of safety-net clinics to examine the preventive service use of approximately 65,000 individuals with SMI (age 18 and over), and compare them to similarly aged individuals without SMI (n > 700,000) to identify patient, provider, organizational, and regulatory predictors of preventive service use. We will also conduct a small number of formative, semi-structured interviews with patients and providers to develop a clinician survey and patient interview materials (structured and semi- structured). Information from clinician surveys will be used to predict preventive service use at the panel level. Semi-structured interviews with patients will be used to identify factors affecting willingness to seek preventive services and barriers to, and facilitators of, such service seeking. This mixed methods study will employ triangulated, complementary, methods to gain a nuanced understanding of factors responsible for disparate and inadequate preventive service use among SMI patients, and to identify possible methods for ameliorating barriers to service use. This information will inform ongoing efforts to improve delivery of medical care to individuals with SMI as well as initiatives targeting excess mortality in this population.