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。差异方法通常没有考虑到具体情况

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.