Organizational Capacity to Eliminate Outcome Disparities under Healthcare Reform

项目概要/摘要 药物滥用治疗领域面临着一个前所未有的挑战，即减少 种族和少数民族人口。获得药物滥用、心理健康和艾滋病毒综合服务 预防保健与积极的健康成果和降低成本有关。的总体目标 拟议的研究是确定《平价医疗法案》（ACA）引发的变化如何影响社区- 基于门诊药物滥用治疗（OSAT）方案的能力，以扩大在种族和 少数族裔社区，并消除非洲裔美国人和拉丁美洲客户之间的结果差异。的 此应用程序的目的是检查当前医疗补助扩展对组织的影响， 以社区为基础的OSAT计划的能力，以提高治疗的获得和保留， 居住在洛杉矶县的少数民族，加州通过开发和分析面板数据集。我们 基于组织发展框架的概念框架研究了 组织能力（即，领导力、变革准备、Medi-Cal计费） 医疗补助计划（在加州称为Medi-Cal）在服务提供方面的扩展（即，心理健康和艾滋病毒 预防服务）以及非裔美国人和拉丁美洲人客户获得和保留治疗的情况。在Aim中 1和2，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， 影响OSAT方案在种族和民族中提供心理健康和艾滋病毒预防服务 少数民族地区，在《中华人民共和国宪法》颁布之前。我们将在2013年、2015年和2017年同样重新调查 147个OSAT项目的代表性样本位于少数民族社区，形成面板数据集。这些 程序数据的重复测量将与管理客户结果数据连接（N~ 10，800 在目标3和4中，在每个数据点检查保险扩展对以下方面的纵向影响： 少数族裔社区的服务提供情况以及非洲裔美国人和拉丁美洲人获得和保留服务的比率 有心理健康和艾滋病毒风险的客户。拟议研究的总体公共卫生影响 包括在公共资助的以社区为基础的OSAT计划中确定有希望的组织因素 为大部分低收入少数族裔客户提供服务，这些客户在ACA之间发挥调解作用， 保险扩展和以客户为中心的流程结果，目标是消除健康差距。

Project Summary/Abstract 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.