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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

基本信息

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
项目类别：
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

项目摘要

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.

总结