Improving rural mental health equity through Medicaid policy evaluation - resubmission

项目总结/摘要 候选人：玛格丽特格林伍德埃里克森是一个早期的职业急诊医生和卫生服务 研究人员寻求改变医疗补助政策，以促进农村心理健康（MH）的公平性。她的长期 我的职业目标是开发一个独立的研究项目，评估医疗补助政策的影响 在农村地区， 代表性不足的少数民族（URM）。这个K 08奖项对她实现这一目标的能力至关重要 通过受保护的时间、培训和有指导的研究。研究背景：有很好的- 在农村环境中，特别是在城市居民点，在解决少数民族问题和同时发生的未成年人问题方面存在有据可查的差距 社区.急诊室（艾德）是农村医疗补助受益人的主要接入点 寻求MH治疗，但此类艾德访视后的结果尚未得到充分研究。医疗补助替代支付模式 （APM）越来越多地部署，以减少昂贵的ED为基础的护理，但有必要检查 杀伤人员地雷对农村和城市居民和少数民族社区卫生保健差距的影响。新墨西哥州（NM）是这项研究的理想地点 作为一个大部分是农村的州，它是全国医疗补助保险率最高的州之一（49%）， 包括大型的美洲原住民（12%）和西班牙裔（48%）社区。这个项目的总体目标是 K 08是一项详细的、以州为基础的研究，在测试NM有效性的同时，测量农村MH差异 医疗补助的APM作为农村和URM社区的干预措施，并在全国范围内检查这些发现， PI研究不同州医疗补助政策干预对农村MH的影响的未来R 01 结果。具体目标：1）测量与下列因素相关的患者、卫生系统和社区因素： 农村医疗补助受益人中MH相关艾德就诊的护理质量差异，2）测试新 墨西哥医疗补助政策在统计上缓和了农村和医疗补助质量之间的关系 衡量绩效，3）确定多州医疗补助政策的关键政策目标和结果指标 评价为了实现这些目标，PI将学习并将先进的统计技术应用于NM 医疗补助索赔，测量农村MH差异的交叉因素并测试NM的有效性 医疗补助的MH APM。然后，PI将召集一个专家小组，在Medicaid中检查这些结果 计划，确定未来多州R 01医疗补助MH政策的措施。职业发展计划： 与导师密切合作，她将1）获得MH服务研究和政策方面的专业知识，2）开发 医疗补助索赔分析，多层次模型和聚类倾向匹配的方法学专业知识，3） 学习进行多州医疗补助政策评估和传播研究成果的框架。 她有杰出的环境和指导支持，包括高层领导，国家顾问， 董事会，和一个CTSC与支持教师的良好记录。政府回应人权事务局局长关于 健康公平（NOT-HS-21-014）和重点人群政策（NOT-HS-21-015）。

PROJECT SUMMARY/ABSTRACT Candidate: Margaret Greenwood-Ericksen is an early career emergency physician and health services researcher who seeks to transform Medicaid policy to advance rural mental health (MH) equity. Her long-term career goal is to develop an independent program of research evaluating the impact of Medicaid policy interventions on MH outcomes, including co-occurring substance use disorder (SUD), in rural and underrepresented minority (URM) communities. This K08 award is vital to her ability to achieve this goal through protected time, training, and mentored research studies. Research Context: There are well- documented disparities in addressing MH and co-occurring SUD in rural settings, particularly amongst URM communities. The Emergency Department (ED) is a major access point for rural, Medicaid beneficiaries seeking MH care, but outcomes after such ED visits are understudied. Medicaid alternative payment models (APMs) are increasingly deployed to reduce expensive ED-based care, but there is a need to examine the impact of APMs on MH disparities in rural and URM communities. New Mexico (NM) is ideal for this research as a largely rural state with one of the nation’s highest Medicaid insurance rates (49%) with a majority-minority composition including large Native American (12%) and Hispanic (48%) communities. The overall goal of this K08 is a detailed, state-based study measuring rural MH disparities while testing the effectiveness of NM Medicaid’s APM as an intervention in rural and URM communities and examining these findings nationally for a future R01 by the PI studying the impact of different states’ Medicaid policy interventions on rural MH outcomes. Specific Aims: 1) Measure patient-, health system-, and community-factors associated with differences in care quality for MH-related ED visits among rural Medicaid beneficiaries, 2) Test how New Mexico Medicaid MH policy statistically moderates the relationship between rurality and Medicaid quality measure performance, 3) Identify key policy targets and outcome measures for multistate Medicaid MH policy evaluation. To accomplish these aims, the PI will learn and apply advanced statistical techniques to NM Medicaid claims, measuring the intersecting factors on rural MH disparities and testing the effectiveness of NM Medicaid’s MH APM. The PI will then convene an Expert Panel to examine these findings across Medicaid programs, identifying measures for a future multistate R01 on Medicaid MH policy. Career Development Plan: Working closely with mentors, she will 1) Acquire expertise in MH services research and policy, 2) Develop methodologic expertise in Medicaid claims analysis, multilevel models, and clustered propensity matching, 3) Learn frameworks for conducting multistate Medicaid policy evaluations and to disseminate research findings. She has outstanding environmental and mentorship support, including top leadership, a national Advisory Board, and a CTSC with a strong track record of supporting faculty. Submission responds to AHRQ’s SEN on Health Equity (NOT-HS-21-014) and Policy on Priority Populations (NOT-HS-21-015).