Organizational Capacity to Eliminate Outcome Disparities under Healthcare Reform

项目摘要/摘要 药物滥用治疗领域面临着前所未有的挑战，以减少 种族和少数民族人口。获得综合药物滥用、心理健康和艾滋病毒 预防保健与积极的健康结果和降低成本有关。该计划的总体目标 拟议的研究旨在确定《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)计划的能力，以扩大在种族和 并消除非洲裔美国人和拉美裔客户之间的结果差异。这个 此应用程序的目标是检查当前扩展的医疗补助对组织的影响 以社区为基础的OSAT方案的能力，以加强治疗、获取和保留 居住在加利福尼亚州洛杉矶县(洛杉矶)的少数族裔通过开发和分析小组数据集。我们的 以组织发展框架为基础的概念框架研究了 调解以下方面的组织能力(即领导力、变革准备情况、中期账单) 扩大医疗补助(在加利福尼亚州称为Medi-Cal)提供服务(即精神健康和艾滋病毒) 预防服务)以及非洲裔美国人和拉丁裔客户的治疗、获取和保留。在AIM 1和2我们将检查基准数据，以改进组织能力因素的概念模型 影响在种族和族裔的OSAT方案中提供心理健康和艾滋病毒预防服务 少数族裔社区，在ACA颁布之前。我们将在2013年、2015年和2017年进行同样的重新调查 将147个分布在少数族裔社区的具有代表性的OSAT项目样本组成一个面板数据集。这些 计划数据的重复测量将与管理客户结果数据(N~10,800 客户)在每个数据点检查目标3和4中保险扩张的纵向影响 少数族裔社区的服务提供情况以及非洲裔美国人和拉美裔美国人的获得率和保留率 有精神健康和艾滋病毒风险状况的客户。拟议研究对公众健康的整体影响 包括在公共资助的基于社区的OSAT计划中确定有前途的组织因素 为很大比例的低收入少数族裔客户提供服务，这些客户在ACA之间发挥着调解作用 保险扩展和以客户为中心的流程成果，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.