BREAST CANCER OUTCOMES IN A DOUBLY DISADVANTAGED POPULATION: MEDICAID BENEFICIARI

描述（由申请人提供）：患有精神疾病（MI）的个人，患有精神分裂症，双相情感障碍，重度抑郁症和/或药物滥用等疾病，也可能存在慢性疾病。然而，我们对他们使用非精神卫生服务的了解非常有限。心肌梗死患者在获得和充分利用卫生服务方面面临许多障碍，包括但不包括经济障碍，以及难以理解和遵守医疗建议或治疗。此外，考虑到精神疾病管理的优先级，MI患者的医疗状况可能比非MI患者受到更少的关注。因此，心肌梗死患者可能无法充分利用急需的卫生服务，导致慢性病的预防和管理不力，发病率和死亡率高于非心肌梗死患者。癌症尤其如此，因为早期发现和接受适当治疗及后续护理是癌症结果的一些最重要的决定因素。尽管在卫生服务利用模式和潜在结局方面存在这些重要差异，但在差异文献中，MI患者很少被确定为人群中的弱势亚组。拟议的研究将通过次要数据分析描述俄亥俄州MI和非MI人群中乳腺癌筛查、诊断、治疗和监测的模式。我们将把重点放在女性乳腺癌，因为它的高患病率，其顺从筛查。鉴于MI患者在医疗补助人群中的显著代表性，我们将使用与俄亥俄州癌症发病率监测系统（OCISS）相关的州医疗补助数据。首先，我们将比较接受医疗补助保险的妇女之间的乳房X光检查与非MI。接下来，在被诊断患有乳腺癌的患者中，我们将确定MI是否与a）就诊时的乳腺癌分期相关; B）早期乳腺癌患者接受明确的主要和辅助治疗;和c）接受指南监测后对非转移性乳腺癌进行初步治疗。通过将我们的研究限制在医疗补助受益人，我们将能够比较MI和非MI患者之间的结果，这些患者具有可比的社会经济地位和各种其他类型的障碍。拟议的研究将为更详细的评估铺平道路，旨在确定阻碍MI患者充分利用医疗服务的具体因素，并制定干预措施，以改善这一双重弱势患者群体的癌症预防和控制策略。同样，这些研究将提高医疗保健提供者和研究界对与MI状态相关的脆弱性的认识，以及在为MI患者设计病例管理计划时特殊考虑的重要性。医疗补助受益人与精神疾病代表一个双重弱势群体，考虑到与每一个医疗补助状态和精神疾病的脆弱性，但相关的研究，这一人群一直缺席的差距文献。通过比较女性乳腺癌相关的护理过程和结果的措施之间的医疗补助保险的妇女和没有精神疾病，拟议的研究将铺平道路，更详细的评估，旨在确定具体的因素，阻碍充分利用医疗服务的MI患者，并在制定干预措施，以改善癌症预防和控制的战略，在这一患者群体。

DESCRIPTION (provided by applicant): Individuals with mental illness (MI), suffering from such conditions as schizophrenia, bipolar disorder, major depression, and/or substance abuse, may also present with chronic medical conditions. Yet our understanding of their use of non-psychiatric health services is very limited. MI patients face numerous barriers to access and adequately utilize health services, including - but not encompassing - financial barriers, and difficulties understanding and being compliant with medical recommendation or treatment. Additionally, given the priority assigned to the management of psychiatric conditions, medical conditions may receive lesser attention in MI than in non-MI patients. Consequently, MI patients are likely to under use much needed health services, resulting in poor prevention and management of chronic diseases and greater morbidity and mortality than that observed in non-MI patients. This is particularly true of cancer, because early detection and receipt of adequate treatment and follow-up care are some of the most important determinants of cancer outcomes. Despite these important differences in patterns of health services utilization, and potential outcomes, MI patients have seldom been identified as a vulnerable subgroup of the population in the disparities literature. The proposed studies will describe patterns of breast cancer screening, diagnosis, treatment, and surveillance in MI and non-MI populations in Ohio, through secondary data analysis. We will focus on female breast cancer because of its high prevalence, and its amenability to screening. Given the significant representation of MI patients in the Medicaid population, we will be using state Medicaid data linked with the Ohio Cancer Incidence Surveillance System (OCISS). First, we will compare receipt of mammography by Medicaid-insured women between those with and without MI. Next, among those diagnosed with incident breast cancer, we will determine whether MI is associated with a) breast cancer stage at presentation; b) receipt of definitive primary and adjuvant treatment in early breast cancer patients; and c) receipt of guideline surveillance after initial treatment for non-metastatic breast cancer. By limiting our studies to Medicaid beneficiaries, we will be able to compare outcomes between MI and non-MI patients who share comparable socio-economic status and various other types of barriers in accessing care. The proposed studies will pave the way for more detailed evaluations aimed at identifying specific factors hindering adequate use of medical services by MI patients, and at developing interventions to improve strategies of cancer prevention and control in this doubly disadvantaged patient population. As well, these studies will raise awareness in the health care provider and research communities relative to the vulnerabilities associated with MI status, and the importance of special considerations in the design of case management programs for MI patients. Medicaid beneficiaries with mental illness represent a doubly disadvantaged population, given the vulnerabilities associated with each of Medicaid status and mental illness, yet studies relevant to this population have been absent from the disparities literature. By comparing female breast cancer-related care process and outcome measures among Medicaid-insured women between those with and without mental illness, the proposed studies will pave the way for more detailed evaluations aimed at identifying specific factors hindering adequate use of medical services by MI patients, and at developing interventions to improve strategies of cancer prevention and control in this patient population.