Understanding Disparities in Preventive Services for Patients with Mental Illness

描述（由申请人提供）：患有严重精神疾病（SMI）-精神分裂症谱系障碍、双相情感障碍-的人的预期寿命比没有SMI的人短约25年。这种早期死亡主要是由于可预防的慢性疾病，包括那些由SMI处方药物的代谢副作用引起或恶化的疾病。除了发生危及生命的慢性疾病的风险增加外，患有SMI的患者可能比没有SMI的患者更不可能接受这些疾病的指南一致性预防护理。然而，鲜为人知的是，预防保健服务的使用与SMI患者的整体模式，或在患者，临床医生，组织或监管层面的可修改的因素，影响摄取的预防服务。已经提出了解决重度精神障碍患者健康差异的新举措，包括在精神病诊所内建立医疗护理之家，以及整合医疗和精神病护理;但由于缺乏评估产生这些差异的潜在因素的研究，因此尚不清楚这些策略是否是最佳方法。我们提出了一个为期5年的混合方法研究，以检查的作用，可修改的监管，组织，供应商，供应商-患者，和患者层面的因素，导致严重精神疾病患者之间的预防服务使用的差异。我们使用来自一个大型非营利综合健康计划和一个同样庞大的安全网诊所网络的电子病历数据，检查约65，000名患有SMI的个人的预防性服务使用情况（18岁及以上），并将其与没有SMI的相似年龄的个体进行比较（n > 700，000）以确定预防性服务使用的患者、提供者、组织和监管预测因素。我们还将与患者和提供者进行少量的形成性半结构化访谈，以制定临床医生调查和患者访谈材料（结构化和半结构化）。来自临床医生调查的信息将用于预测小组水平的预防性服务使用。将采用半结构化的病人访谈，以确定影响寻求预防服务的意愿的因素，以及寻求这种服务的障碍和促进因素。 这种混合方法的研究将采用三角形，互补，方法来获得一个细致入微的理解的因素，负责不同的和不充分的预防服务使用的SMI患者，并确定可能的方法，改善服务使用的障碍。这些信息将为改善重度精神障碍患者医疗服务的持续努力以及针对这一人群死亡率过高的举措提供信息。 公共卫生相关性：患有严重精神疾病的人的预期寿命比没有这些疾病的人短约25年。这种早期死亡大多是由于可预防的慢性疾病，但这些患者可能比没有精神疾病的人更不可能接受预防性护理。我们建议确定可修改的监管，组织，供应商，供应商-患者，和患者层面的因素，有助于在预防性服务使用严重精神疾病患者中的病人。这一信息将有助于为降低这一人群的早期死亡率提供信息。

DESCRIPTION (provided by applicant): The life expectancy of people with serious mental illness (SMI)-schizophrenia spectrum disorders, bipolar disorders-is about 25 years shorter than that those without SMI. This early mortality is due largely to preventable chronic conditions, including those caused or worsened by the metabolic side effects of medications prescribed for SMI. In addition to being at increased risk for life-threatening chronic conditions, patients with SMI may be less likely than those without SMI to receive the guideline-concordant preventive care for these disorders. Little is known, however, about overall patterns of preventive care service use among patients with SMI, or about modifiable factors at the patient, clinician, organizational, or regulatory level that affect uptake of preventive services. New initiatives to address health disparities experienced by individuals with SMI have been proposed, including creating medical care homes within psychiatric clinics and integrating medical and psychiatric care; yet it is unclear if such strategies represent the best approaches, given the dearth of research assessing the underlying factors that produce these disparities. We propose a 5-year, mixed methods study to examine the role of modifiable regulatory-, organizational-, provider-, provider-patient-, and patient-level factors contributing to disparities in preventive service use among patients with serious mental illness. We use electronic medical record data from a large non-profit integrated health plan and an equally large network of safety-net clinics to examine the preventive service use of approximately 65,000 individuals with SMI (age 18 and over), and compare them to similarly aged individuals without SMI (n > 700,000) to identify patient, provider, organizational, and regulatory predictors of preventive service use. We will also conduct a small number of formative, semi-structured interviews with patients and providers to develop a clinician survey and patient interview materials (structured and semi- structured). Information from clinician surveys will be used to predict preventive service use at the panel level. Semi-structured interviews with patients will be used to identify factors affecting willingness to seek preventive services and barriers to, and facilitators of, such service seeking. This mixed methods study will employ triangulated, complementary, methods to gain a nuanced understanding of factors responsible for disparate and inadequate preventive service use among SMI patients, and to identify possible methods for ameliorating barriers to service use. This information will inform ongoing efforts to improve delivery of medical care to individuals with SMI as well as initiatives targeting excess mortality in this population. PUBLIC HEALTH RELEVANCE: The life expectancy of people with serious mental illnesses is about 25 years shorter than that those without these conditions. Most of this early mortality is due to preventable chronic diseases, but these patients may be less likely than those without mental illnesses to receive preventive care. We propose to identify modifiable regulatory, organizational-, provider-, provider-patient, and patient-level factors that contribute to disparites in preventive service use among patients with serious mental illnesses. This information will be useful to inform efforts to reduce early mortality in this population.