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Using Medicaid data to advance care for people with schizophrenia at risk for HIV (Medicaid-DASH)

利用医疗补助数据促进对有艾滋病毒风险的精神分裂症患者的护理 (Medicaid-DASH)

基本信息

批准号：
9903937
负责人：
Christina Mangurian
金额：
$ 24.98万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-01 至 2023-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9903937
关键词：
Address Age Area Award Bipolar Disorder Caring Categories Communicable Diseases Continuity of Patient Care Data Data Set Development Diagnosis Dimensions Epidemic Epidemiologic Methods Ethnic Origin Foundations Frequencies Funding General Population Geography Goals HIV Health Heterogeneity Human immunodeficiency virus test Individual Inequality Intervention Knowledge Medicaid Mentored Research Scientist Development Award Mentors Methodology Methods Outcome Parents Patient Self-Report Population Positioning Attribute Race Recording of previous events Research Research Methodology Research Personnel Retrospective cohort Risk Sample Size Schizophrenia Social Hierarchy Social Identification Statistical Methods Testing Time Training United States United States National Institutes of Health Vulnerable Populations Work administrative database black men care outcomes career career development cohort cost effective intervention experience health disparity health inequalities improved improved outcome intersectionality intravenous drug use lens marginalized population member parent grant public health intervention severe mental illness sex skills social social determinants social epidemiology social exclusion transmission process

项目摘要

PROJECT SUMMARY/ABSTRACT People with severe mental illness (e.g., schizophrenia, bipolar disorder; SMI) are a socially marginalized population with up to ten times increased likelihood of being diagnosed with HIV compared to the general United States population. The parent grant (R01-MH112420) aims to investigate the increased HIV transmission risk, low testing rate, and potential HIV treatment gaps for people with SMI using a large, geographically diverse national retrospective longitudinal Medicaid cohort. The outcomes assessed by the parent grant, however, may be modified by membership in intersecting categories of social marginalization. Single-axis interventions that do not consider heterogeneities among vulnerable populations may not be effective in improving outcomes and achieving epidemic control. Therefore, research is needed to identify and assess the magnitude of outcome inequalities among the riskiest intersectional positions. Leveraging twelve years of Medicaid data (2001 through 2012), the major goal of this research is to assess the existence and magnitude of outcome inequalities along the HIV continuum of care, with respect to intersecting categories of social marginalization (e.g. schizophrenia diagnosis, race/ethnicity, sex, intravenous drug use, etc.). The diversity supplement seeks to provide mentored theoretical and methodological training for the candidate in the area of quantitative intersectionality research. The proposed career development aims are: (1) to develop foundational knowledge in intersectionality as a theoretical framework; and (2) to develop expertise in quantitative intersectionality research methods. Aligned with the career development objectives, the research goals of the proposed study are to: (a) research the cutting-edge quantitative intersectionality approaches to assess the existence and magnitude of HIV outcome inequalities within a large administrative database; (b) examine differential rates of HIV testing by intersecting categories of schizophrenia diagnosis, sex, age, history of intravenous drug use, and race/ethnicity in the R01 parent grant retrospective cohort; and (c) examine differential rates of treatment for HIV by intersecting categories of schizophrenia diagnosis, sex , age, history of intravenous drug use, and race/ethnicity in the R01 parent grant retrospective cohort. The evidence generated from this work could identify the riskiest intersectional positions to inform targeted, cost- effective, interventions to improve HIV testing and care outcomes among those most vulnerable. Additionally, the foundational knowledge of intersectionality as a theoretical framework, paired with the application of quantitative intersectionality methods to a large administrative data set, will position the candidate to have an impactful career as an independent investigator generating rigorous quantitative evidence demonstrating health inequities among socially marginalized populations.

项目总结/文摘