Effects of Hospital-Community-Public Health Integration on Racial and Ethnic Disparities in Mental Health

医院-社区-公共卫生一体化对心理健康中种族和民族差异的影响

• 批准号: 10021780
• 负责人: Jie Chen
• 金额: $ 8.36万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-12 至 2022-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10021780
• 关键词: Address; Adoption; Affordable Care Act; African American; Clinical; Communities; Community Health; Community Hospitals; Data; Data Set; Ethnic group; Focus Groups; Goals; Health; Health Care Reform; Health Care Sector; Health Personnel; Health Policy; Health Resources; Health Services Research; Health Status; Health system; Healthcare; Healthcare Systems; Hospital Administrators; Hospitalization; Hospitals; Individual; Latino; Laws; Link; Medical; Mental Health; Mental disorders; Mentally Ill Persons; Methods; Minority; Mission; Modeling; Morbidity - disease rate; Outcome; Patient Representative; Patients; Plant Roots; Policies; Population; Preventive Intervention; Provider; Public Health; Public Housing; Research; Research Personnel; Role; Service delivery model; Services; Social Values; Social Work; Source; System; Target Populations; Time; Transportation; Underserved Population; Variant; Work; base; behavioral health; care coordination; community partnership; cost; cost effective; design; disparity reduction; ethnic health disparity; ethnic minority population; experience; health care availability; health care delivery; health care settings; health disparity; hospital readmission; improved; innovation; minority health; mortality; patient engagement; patient population; physical conditioning; population health; preference; programs; racial and ethnic; racial and ethnic disparities; racial minority; response; social health determinants; social stigma; sociodemographics

Summary Mental illness is a major public health concern in the U.S. and a significant source of morbidity and mortality. Racial and ethnic minority patients experience disproportionate burdens of common physical health conditions associated with mental illness, largely due to the lack of health care access and social stigma. Effectively treating mental illness and the associated conditions will depend on a comprehensive approach that crosses health systems and policies, such as the Community Benefit State Laws, to target “Population Health” and emphasize the value of social determinants of health. However, the current mental health care system works in a silo, and evidence of care coordination on health disparities is lacking. The goal of this study is to examine system-level care coordination among hospitals, communities, and public health agencies, and to estimate its impacts on unmet health care needs in African American and Latino patients with mental illness. The rationale for the proposed research is that once it is known what specific coordination practices (e.g. medical services, transportation, public housing) and policies are most successful for different patient populations, integration of mental and physical health care delivery systems can be designed in a more cost-effective way to overcome the barriers from stigma and limited health care access. In this project, we will first determine the effects of Community Benefit State Laws on racial and ethnic disparities in health care access, quality, and costs among people with mental illness (Aim 1). Within this context, we will further identify the variation of hospital-based adoption of care coordination practices and its correlation with patient and community level socio- demographics, local public health resources, and the extent of the implementation of community benefit laws (Aim 2); and determine the impact of care coordination practices between hospitals, communities, and public health agencies on racial and ethnic health disparities (Aim 3). We will use mixed methods: (1) we will construct a multi-level data set by linking multiple nationally representative data sets and use difference-in- differences approach to estimate the impact of system-level care coordination on different racial/ethnic groups; and (2) we will investigate challenges to implementing system-level coordination using focus groups of racial and ethnic minority patient representatives, hospital administrators and providers, and representatives from public health agencies. The proposed research is significant because (1) identified practices are expected to provide evidence on how to personalize mental health care coordination for racial and ethnic minority patients to address heterogeneous preferences in mental health treatment; (2) identified system-level care coordination practices are expected to be cost-effective, which in turn can make the coordination sustainable for underserved populations. Our results are expected to break down longstanding silos and bridge the gap between health care providers, community based organizations, social service agencies, and the public health sector delivery system, in addition to providing evidence to reduce health disparities through care coordination.

概括 精神疾病是美国的一个主要公共卫生问题，也是发病率和死亡率的重要来源。 少数族裔患者承受着不成比例的常见身体健康状况负担 与精神疾病相关，主要是由于缺乏医疗保健机会和社会耻辱。有效地 治疗精神疾病及相关病症将取决于跨领域的综合方法 卫生系统和政策，例如社区福利州法律，以“人口健康”为目标 强调健康社会决定因素的价值。然而，目前的精神卫生保健系统在 缺乏针对健康差异的护理协调的证据。这项研究的目的是检查 医院、社区和公共卫生机构之间的系统级护理协调，并估计其 对非裔美国人和拉丁裔精神疾病患者未满足的医疗保健需求的影响。理由 对于拟议的研究来说，一旦了解了具体的协调实践（例如医疗服务、 交通、公共住房）和政策对于不同的患者群体最为成功，整合 可以以更具成本效益的方式设计精神和身体保健提供系统，以克服 耻辱和有限的医疗保健机会带来的障碍。在这个项目中，我们将首先确定以下效果： 社区福利州关于医疗保健获取、质量和费用方面种族和民族差异的法律 患有精神疾病的人（目标 1）。在此背景下，我们将进一步确定基于医院的差异 采用护理协调实践及其与患者和社区层面社会层面的相关性 人口统计、当地公共卫生资源以及社区福利法的实施程度 （目标 2）；确定医院、社区和公众之间护理协调实践的影响 卫生机构关注种族和民族健康差异（目标 3）。我们将使用混合方法：（1）我们将 通过链接多个具有全国代表性的数据集并使用差异来构建多级数据集 采用差异法来估计系统级护理协调对不同种族/族裔群体的影响； (2) 我们将利用种族焦点小组调查实施系统级协调的挑战 和少数民族患者代表、医院管理人员和提供者以及来自 公共卫生机构。拟议的研究意义重大，因为 (1) 已确定的实践预计将 提供有关如何为少数族裔患者提供个性化心理保健协调的证据 解决心理健康治疗中的不同偏好； (2) 确定系统级护理协调 预计做法将具有成本效益，这反过来又可以使协调可持续 服务不足的人群。我们的结果预计将打破长期存在的孤岛并弥合差距 卫生保健提供者、社区组织、社会服务机构和公共卫生部门之间 部门提供系统，此外还提供通过护理协调减少健康差异的证据。