Detection, Understanding and Reduction of Latino Health Care Disparities

 描述（由申请人提供）：虽然拉丁美洲人是进入物质使用障碍（SUD）治疗的增长最快的人口之一，但他们最有可能缺乏健康保险，并在治疗途径，质量和结果方面接受不同的护理。特别是，墨西哥裔美国人是美国没有保险和服务严重不足的少数民族中人数最多的。因此，医学研究所（IOM）和其他联邦机构呼吁系统收集特定拉丁裔亚群10的医疗保健数据，以确定弱势亚群，确定差异的决定因素，并为医疗保健系统制定促进健康公平的解决方案做好准备。缺乏具有足够数量的墨西哥裔美国人的代表性数据集和关于提供者护理质量的信息，以准确探索和识别医疗保健差异，这是改善墨西哥裔美国人治疗结果的策略的主要障碍。5因此，使用多层次和多年数据集，其中包括从101个门诊SUD治疗项目和14个治疗项目中收集的数据，2011年和2013年有610名客户，我们将设法发现国际移徙组织定义的客户在成功完成治疗后30天清醒的差异。在基尔本、瑞士人、海曼、克劳利-马托卡和法恩（2006）关于推进健康差异研究的概念框架的指导下，并与国家健康和临床卓越研究所（NICE）关于公共健康的概念框架保持一致，我们将在个人和项目层面上研究这些差异。目标1将侧重于检测墨西哥裔美国人和非拉丁裔白人之间的治疗差异，目标2将侧重于了解关键组织因素（例如，接受公共保险，提供循证治疗[EBT]，提供文化和语言上适当的服务[CLAS]）可能有助于减少这些治疗差异。目标3旨在通过测试项目对公共保险的接受程度（即，医疗补助），这将扩大作为ACA的一部分，主要影响拉丁美洲人在洛杉矶县，可能会导致改善护理质量（即，EBT和CLAS的交付）。对现有数据的拟议分析代表了一个及时和具有成本效益的机会，对拉丁美洲人的医疗保健差异研究和政策产生了巨大的整体影响，特别是考虑到拟议研究的创新方面是检测，理解和减少墨西哥裔美国人的客户和计划层面的差异，他们构成了美国最大的拉丁美洲人亚组。最后，鉴于越来越多的关注医疗保健改革及其后果（积极和消极），拟议的研究被认为具有高的整体影响的潜力，因为它将是第一个已知的研究，以检查在何种程度上增加接受公共医疗保险，这是ACA的一个关键组成部分，导致在以社区为基础的SUD治疗的护理质量的提高。

 DESCRIPTION (provided by applicant): Although Latinos represent one of the fastest-growing populations entering substance use disorder (SUD) treatment, they are the most likely to lack health insurance and receive disparate care in terms of treatment access, quality, and outcomes. In particular, Mexican Americans represent the largest population of uninsured and critically underserved ethnic minority individuals in the United States. As such, it is not surprisng that the Institute of Medicine (IOM) and other federal institutions have called for systematic collection of health care data on specific Latino subgroups10 to define vulnerable subpopulations, identify determinants of disparities, and prepare the health care system to develop solutions to promote health equities. The lack of representative datasets with an adequate number of Mexican Americans and information on provider quality of care to accurately explore and identify health care disparities has represented a key barrier to greater knowledge regarding strategies to improve Mexican Americans' treatment outcomes.5 Thus, using a multilevel and multiyear dataset, which includes data collected from 101 outpatient SUD treatment programs and 14,610 clients in 2011 and 2013, we will seek to detect IOM-defined disparities in terms of client achievement of 30- day sobriety at successful treatment completion. Guided by Kilbourne, Switzer, Hyman, Crowley-Matoka, and Fine's (2006) conceptual framework for advancing health disparities research, and consistent with the National Institute for Health and Clinical Excellence's (NICE) conceptual framework for public health,15 we will examine these disparities at both the individual and program level. Aim 1 will focus on detection of treatment disparities between Mexican-Americans and non-Latino Whites and Aim 2 will focus on understanding the extent to which key organizational factors (e.g., acceptance of public insurance, delivery of evidence-based treatment [EBT], and delivery of culturally and linguistically appropriate services [CLAS]) may help in the reduction of these treatment disparities. Aim 3 seeks to expand upon the NICE conceptual framework by testing the extent to which increases in programs' acceptance of public insurance (i.e., Medicaid), which will expand as part of the ACA and mostly affect Latinos in Los Angeles County, may lead to improvements in quality of care (i.e., delivery of EBT and CLAS). The proposed analysis of existing data represents a timely and cost-efficient opportunity to have a large overall impact on Latino health care disparities research and policy, especially given the innovative aspect of the proposed research is to detect, understand and reduce client- and program- level disparities for Mexican Americans, who constitute the largest Latino subgroup in the United States. Finally, given the increasing focus on health care reform and its consequences (both positive and negative), the proposed study is believed to have the potential for high overall impact because it will be one of the first known studies to examine the extent to which increases in acceptance of public health insurance, which is a key component of the ACA, lead to increases in quality of care in community-based SUD treatment.