Comparative Effectiveness Research Diffusion and Mental Health Care Disparities

描述（由申请人提供）：比较有效性研究（CER）比较不同治疗方法的益处和风险。然而，人们对 2010 年平价医疗法案 (ACA) 中设想的大规模 CER 实施对跨种族/族裔群体医疗保健公平性的影响知之甚少。确定 FDA 风险警告对精神药物使用差异的影响，为了解 CER 在某些情况下如何影响差异提供了一个平台。视差方法通常没有考虑具体的情况 关于有效性和安全性的建议和警告。随着《平价医疗法案》的出现以及对持续存在的差异的持续关注，继续进行差异研究势在必行 不断发展以吸收从 CER 中吸取的经验教训。 我们利用警告和建议的时间趋势来了解扩散的差异，旨在确定可能避免将核证减排量纳入常规实践所带来的负资产后果的政策。具体来说，我们 1) 按种族/族裔群体跟踪青少年抗抑郁药物使用以及青少年和成人抗精神病药物使用的变化，因为他们受到 CER 生成的风险警告和建议的影响； 2) 评估 FDA 警告中的具体信息是否影响 a) CER 生成的证据推荐的治疗方法（例如，氟西汀的使用和抗精神病药物使用者的代谢筛查）； b) 使用具有潜在危害的精神药物（例如使用奥氮平）； 3) 确定 HMO 注册的提供者特征如何作为通过健康风险警告进行 CER 差异扩散的机制。 我们实施医学研究所 (IOM) 对医疗保健差异的定义，以捕捉差异随时间变化的趋势，覆盖与抗抑郁药和抗精神病药物相关的警告和建议的时间表。我们通过将整体药物使用的差异分解为 FDA 警告中提到的具有特定风险或益处的特定使用类别的差异来调整 IOM 方法。如果我们发现风险警告和建议的传播存在种族/族裔差异，这表明政策制定者应重点关注提高少数群体对核证减排量的采用。如果我们发现某些提供者和 HMO 成员资格会影响扩散的差异，这将导致向政策制定者提出可行政策的建议，以避免将 CER 纳入日常实践所带来的负公平后果。

DESCRIPTION (provided by applicant): Comparative Effectiveness Research (CER) compares benefits and risks of different treatments. However, little is known about the impact of large-scale CER implementation as conceived in the 2010 Affordable Care Act (ACA) on equity in health care across racial/ethnic groups. Identifying the influence of FDA risk warnings on disparities in psychotropic drug use provides a platform to understand how CER will influence disparities in certain situations. Disparity methods have typically not taken into account specific recommendations and warnings on effectiveness and safety. With the advent of the ACA and continued concern over persistent disparities, it is imperative that disparities research continues to evolve to incorporate lessons learned from CER. We capitalize upon time trends in warnings and advisories to understand disparities in diffusion with the intention of identifying policies tht might avert the negative equity consequences of incorporating CER into routine practice. Specifically, we 1) Track changes in antidepressant use among youth and antipsychotic drug use among youth and adults by racial/ethnic group as they are influenced by CER-generated risk warnings and advisories; 2) Assess whether specific information in FDA warnings influenced disparity trends in a) treatments recommended by CER-generated evidence (e.g., fluoxetine use and metabolic screening for antipsychotic users); and b) psychotropic drug use that is potentially harmful (e.g., olanzapine use); and 3) Identify how provider characteristics an HMO enrollment act as mechanisms that underlie the differential diffusion of CER via health risk warnings. We implement the Institute of Medicine (IOM) definition of healthcare disparities in order to capture trends in disparities over time, overlaying timelines of warnings and recommendations related to antidepressant and antipsychotic drugs. We adapt IOM methods by decomposing disparities in overall drug use into disparities in specific categories of use mentioned by FDA warnings as carrying particular risk or benefit. If we find racial/ethnic disparities in diffusion of risk warnings and advisories, this suggests policymakers should focus on improving uptake of CER among minorities. If we identify that certain providers and HMO membership influences disparities in diffusion, this will lead to recommendations for policymakers of actionable policies to avert the negative equity consequences of incorporating CER into routine practice.