Understanding Disparities in Preventive Services for Patients with Mental Illness

了解精神疾病患者预防服务的差异

• 批准号: 8437984
• 负责人: Carla A. Green
• 金额: $ 79.59万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8437984
• 关键词: Address; Adult; Adverse effects; Affect; Age; Bipolar Disorder; Caring; Characteristics; Chronic; Chronic Disease; Clinic; Community Mental Health Centers; Community Networks; Computerized Medical Record; County; Data; Development; Diagnosis; Disease; Excess Mortality; Federally Qualified Health Center; Goals; Guidelines; Health Planning; Health system; Home environment; Individual; Intervention; Interview; Life; Life Expectancy; Major Depressive Disorder; Measures; Medical; Mental Health Services; Mental disorders; Metabolic; Methods; Morbidity - disease rate; Patients; Pattern; Perception; Pharmaceutical Preparations; Population; Prevention; Preventive; Primary Health Care; Provider; Psychiatric therapeutic procedure; Quality of life; Research; Research Design; Risk; Role; Schizophrenia; Series; Services; Structure; Surveys; System; Terminology; Testing; Underserved Population; Vulnerable Populations; aged; base; care systems; experience; health disparity; improved; mortality; patient home care; safety net; severe mental illness; uptake; willingness

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.

描述(申请人提供)：患有严重精神疾病(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严重精神疾病的人短约25岁。早期死亡在很大程度上是由于可预防的慢性疾病，包括那些由治疗SMI的药物的代谢副作用引起或恶化的疾病。除了患有危及生命的慢性疾病的风险增加外，患有SMI的患者接受这些疾病的符合指南的预防性护理的可能性可能比没有SMI的患者更低。然而，关于SMI患者预防保健服务使用的总体模式，或者患者、临床医生、组织或监管层面上影响预防服务接受的可修改因素，人们知之甚少。已经提出了解决重度精神障碍患者所经历的健康差距的新举措，包括在精神科诊所内建立医疗疗养院，并将医疗和精神护理结合起来；然而，鉴于缺乏评估造成这些差距的潜在因素的研究，目前尚不清楚这些战略是否代表最佳方法。我们提出了一项为期5年的混合方法研究，以检验可修改的监管、组织、提供者、提供者-患者和患者水平的因素对严重精神疾病患者预防服务使用差异的影响。我们使用一个大型非营利性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来检查大约65,000名患有SMI的患者(18岁及以上)的预防性服务使用情况，并将他们与没有SMI的相似年龄的个人(N&>700,000)进行比较，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。我们还将对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被用来预测小组层面的预防性服务使用。对患者的半结构化访谈将被用来确定影响寻求预防性服务意愿的因素，以及寻求此类服务的障碍和促进者。 这项混合方法研究将使用三角、互补的方法，以获得对导致SMI患者不同和不充分的预防性服务使用的因素的细微差别的理解，并确定改善服务使用障碍的可能方法。这一信息将为改善向重度精神分裂症患者提供医疗服务的持续努力以及针对这一人群过高死亡率的倡议提供信息。 与公共卫生相关：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岁。大多数早期死亡是由于可预防的慢性病，但这些患者接受预防性护理的可能性可能低于那些没有精神疾病的患者。我们建议确定可改变的法规、组织、提供者、提供者-患者和患者水平的因素，这些因素导致严重精神疾病患者在预防性服务使用方面的差异。这些信息将有助于为减少该人群早期死亡率所做的努力提供信息。