Improving Minority Health by Monitoring Medicaid Quality, Disparities and Value

项目摘要 治疗精神分裂症患者需要广泛的服务，包括身体健康护理 这些服务主要由医疗补助提供资金。尽管医疗保健费用很高，但大多数患者并没有 少数民族接受建议的护理的可能性低于白人。此外，患者居住的地方 问题，质量和质量差异不仅在州之间，而且在州内的县之间也各不相同。 states.在改革和财政紧缩的时期，医疗补助计划面临着提高质量和 减少高需求受益者之间的质量差距，包括精神分裂症患者， 成本可能影响项目成功的因素包括：1）全面衡量项目质量的能力; 护理，涵盖心理健康和身体健康护理的关键领域，2）有效可行地衡量 定期提供给受益人的护理的价值，重要的是，3）纳入种族/民族 价值评估的差异。这种衡量工作应在以下一级进行： 有意义的地理单位，如县，其中卫生保健模式受政策影响 反映州和地方的优先事项。作为对FOA 16-221的回应，我们提出了一个研究计划， 旨在减少健康差距，改善少数民族人口的健康， 通过测量质量差异和医疗补助资助的护理的其他关键领域， 分发给生活在五个不同州的精神分裂症成年人。我们会用证据来衡量质量- 基于指标，并利用心理测量原理，我们将创建一个整体综合评分，以及 关键子分数。使用综合措施，我们将评估种族/民族和地理差异， 整体护理质量;价值，定义为医疗补助国家计划产生高质量护理的成本; 以及消除种族/民族质量差异的计划的成本。我们将质量和成本结合起来 通过独特的成本效益方法，据我们所知，我们的工作将是第一个 将严重精神疾病护理的差异和费用定量联系起来。我们的最终目标是提供 政策制定者使用用户友好的交互式工具来监测质量、质量差异、成本和价值， 促进循证决策。目标1将评估教育质量方面的种族/族裔和地理差异， 精神健康、身体健康和常规向精神分裂症受益人提供的总体保健。 目标2将制定和实施一个成本效益框架，以评估价值， 增加的护理净货币福利。目标3将使用全州白色人口作为参考 标准，以确定在每个县消除种族/民族质量差距的成本。Aim 4将开发 并试行一个用户友好的互动工具，使国家医疗补助计划，以监测质量，差距，成本， 关怀的价值。我们希望拟议的研究将有助于消除差距， 先进的绩效测量技术，将使医疗补助护理的例行监测。

PROJECT SUMMARY Treating individuals with schizophrenia requires a broad array of services, including physical health care services, which are primarily financed by Medicaid. Despite high health care costs, most patients do not receive recommended care, and minorities are less likely to do so than whites. Moreover, where patients live matters, with quality and quality disparities varying not just among states but also among counties within states. At a time of reform and fiscal constraint, Medicaid programs are challenged with improving quality and reducing quality disparities among high-needs beneficiaries, including those with schizophrenia, at no extra costs. Factors likely to impact a program’s success include its ability to 1) comprehensively measure quality of care, capturing key domains of both mental health and physical health care, 2) validly and feasibly measure the value of care routinely delivered to their beneficiaries, and importantly, 3) incorporate racial/ethnic disparities in the assessment of value. Such measurement efforts should be undertaken at the level of meaningful geographic units such as counties, where patterns of health care are influenced by policies reflecting both state and local priorities. In response to FOA 16-221, we propose a program of research that seeks to reduce health disparities and improve the health of minority populations served in publicly funded settings through measurement of quality disparities and other critical domains of Medicaid-financed care delivered to adults with schizophrenia living in five diverse states. We will measure quality using evidence- based indicators, and exploiting psychometric principles, we will create an overall composite score as well as key sub-scores. Using the composite measure, we will assess racial/ethnic and geographic disparities in overall quality of care; value, defined as the cost to the Medicaid state program of producing high-quality care; and the cost to the program of eliminating racial/ethnic disparities in quality. We will integrate quality and costs through a unique cost-effectiveness methodology, and to our knowledge, our work will be the first to quantitatively link disparities and costs of serious mental illness care. Our ultimate goal is to provide policymakers with a user-friendly interactive tool to monitor quality, quality disparities, costs, and value, thus enabling evidence-based policymaking. Aim 1 will assess racial/ethnic and geographic disparities in quality of mental health, physical health, and overall health care routinely delivered to beneficiaries with schizophrenia. Aim 2 will develop and implement a cost-effectiveness framework to assess value, operationalized as the incremental net monetary benefit of care. Aim 3 will use the statewide white population as a reference standard to determine the cost of eliminating racial/ethnic quality disparities in each county. Aim 4 will develop and pilot a user-friendly interactive tool to enable state Medicaid programs to monitor quality, disparities, costs, and value of care. We expect that the proposed research will contribute to the eradication of disparities through advanced performance measurement techniques that will enable routine monitoring of Medicaid care.