Organizational Capacity to Eliminate Outcome Disparities under Healthcare Reform

消除医疗改革结果差异的组织能力

• 批准号: 8535048
• 负责人: Erick Guerrero
• 金额: $ 26.36万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2015-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8535048
• 关键词: AIDS prevention; Address; Administrator; African American; California; Caring; Client; Communities; County; Data; Data Set; Development; Economics; Elements; Ethnic Origin; Face; Funding; Goals; Grant; HIV risk; Health; Health Care Reform; Healthcare; Improve Access; Incentives; Insurance; Latino; Leadership; Los Angeles; Low income; Measures; Mediating; Medicaid; Mental Health; Minority; Minority Groups; Modeling; Nature; Organizational Models; Outcome; Outpatients; Performance; Phase; Play; Policies; Policy Maker; Positioning Attribute; Process; Provider; Public Health; Quality of Care; Race; Readiness; Research; Role; Sampling; Services; Statutes and Laws; Subgroup; Substance abuse problem; System; Testing; Underrepresented Minority; addiction; base; care systems; cost; design; ethnic minority population; evidence base; health disparity; innovation; parity; prevention service; programs; public health relevance; racial and ethnic; response; substance abuse treatment; theories; treatment organization; treatment program

DESCRIPTION (provided by applicant): The substance abuse treatment field faces an unprecedented challenge to reduce health disparities among racial and ethnic minority populations. Access to integrated substance abuse, mental health, and HIV prevention care is associated with positive health outcomes and reduced cost. The overall goal of the proposed study is to identify how changes precipitated by the Affordable Care Act (ACA) impact community- based outpatient substance abuse treatment (OSAT) program capacity to expand service delivery in racial and ethnic minority communities and eliminate outcome disparities among African American and Latino clients. The objective for this application is to examine the organizational impact of the current expansion of Medicaid on the capacity of community-based OSAT programs to enhance treatment access and retention among minorities residing in Los Angeles County (L.A.), California by developing and analyzing a panel dataset. Our conceptual framework, grounded in organizational development frameworks investigates the role of organizational capacity (i.e., leadership, readiness for change, Medi-Cal billing) in mediating the effect of Medicaid expansion (referred as Medi-Cal in California) on service delivery (i.e., mental health and HIV prevention services) and on treatment access and retention among African American and Latino clients. In Aim 1 and 2 we will examine baseline data to refine our conceptual model of organizational capacity factors likely to impact the delivery of mental health and HIV prevention services in OSAT programs in racial and ethnic minority communities, prior to ACA enactment. We will resurvey in 2013, 2015 and 2017 the same representative sample of 147 OSAT programs located in minority communities to form a panel data set. These repeated measures of program data will be concatenated with administrative client outcome data (N~10,800 clients) at each data point to examine in Aims 3 and 4 the longitudinal impact of insurance expansion on service delivery in minority communities and rates of access and retention among African American and Latino clients with mental health and HIV risk conditions. The overall public health impact of the proposed study includes identifying promising organizational factors among publicly funded community-based OSAT programs that serve large proportions of low-income minority clients that play a mediating role between the ACA insurance expansion and client-centered process outcomes with the goal of eliminating health disparities.

描述（由申请人提供）：药物滥用治疗领域面临着前所未有的挑战，以减少种族和少数民族人口之间的健康差距。获得综合药物滥用，心理健康和艾滋病毒预防护理与积极的健康成果和降低成本有关。拟议研究的总体目标是确定《平价医疗法案》（ACA）促成的变化如何影响基于社区的门诊药物滥用治疗（OSAT）计划的能力，以扩大种族和少数民族社区的服务提供，并消除非洲裔美国人和拉丁美洲客户之间的结果差异。本申请的目的是检查当前医疗补助扩展对基于社区的OSAT计划的能力的组织影响，以提高居住在洛杉矶县（L.A.）的少数民族的治疗机会和保留率，加州通过开发和分析面板数据集。我们的概念框架，在组织发展框架的基础上，调查了组织能力的作用（即，领导力、变革准备、Medi-Cal计费） 医疗补助扩展（在加州称为Medi-Cal）对服务提供的影响（即，心理 卫生和艾滋病毒预防服务）以及非洲裔美国人和拉丁美洲人客户获得和保留治疗的情况。在目标1和2中，我们将检查基线数据，以完善我们的组织能力因素的概念模型，这些因素可能会影响种族和少数民族社区OSAT计划中精神健康和艾滋病预防服务的提供。我们将在2013年，2015年和2017年重新调查位于少数民族社区的147个OSAT项目的相同代表性样本，以形成一个面板数据集。这些重复测量的方案数据将与每个数据点的行政客户结果数据（N~ 10 800客户）连接起来，以在目标3和4中检查保险扩展对少数族裔社区服务提供的纵向影响，以及患有精神健康和艾滋病毒风险状况的非裔美国人和拉丁美洲客户的获得和保留率。拟议研究的整体公共卫生影响包括在公共资助的基于社区的OSAT计划中确定有前途的组织因素，这些计划为大部分低收入少数民族客户提供服务，这些客户在ACA保险扩展和以客户为中心的过程结果之间发挥中介作用，目标是消除健康差距。