Reducing Health Disparities in SMI, Rural and Minority Populations

 描述（由申请人提供）：65岁以下有资格享受医疗保险的残疾人（MD<65）似乎在获得医疗保健方面面临独特的挑战，健康状况不佳，护理费用高，尽管对人口的研究仍然有限。共病和严重的精神疾病似乎加强了残疾和不良健康结果之间的联系。本研究通过检查自我护理能力，其与健康状况的关系，以及在14年的时间内，选定的疾病轨迹和健康结果，考虑社区支持健康的能力，医疗保健质量以及性别，种族和农村的交叉影响，来解决MD<65的残疾和共病精神疾病的影响。将比较三组MD<65的医疗保健经历：身体残疾（PHYS）、身体残疾伴精神障碍（CMD）和严重精神疾病残疾（SMI），然后与65岁及以上的医疗保险接受者进行对比。研究设计和分析由两名PI开发的经验支持的多因素健康结局模型指导。研究人员将使用医疗保险当前受益人调查（MCBS）和医疗保险索赔数据（MCD），采用多层次分析，首先检查社区能力对47，680名医疗保险接受者的自我保健能力和健康状况的影响，MD<65，PHYS，CMB和SMI与MD>65对比。接下来，将为患有心血管疾病（CVD）和糖尿病（DM）的患者（残疾人中常见的合并症）构建详细的14年纵向医疗保健概况。采用纵向、群体分析设计，研究者将估计生存率 健康/疾病轨迹的选定结果，包括死亡率在每一组。在每一层次的分析中，研究人员还将研究性别、种族和农村的影响，以评估每种身份的交叉效应进一步影响所见的发病率和死亡率差异的程度。医疗保险索赔数据与我们将在拟议研究中使用的其他数据集的汇总将使我们能够确定社区水平和卫生系统因素，这些因素导致健康状况恶化，利用率增加和高医疗保健成本，从而使调查人员能够为个人和系统水平的医疗保健干预措施提出具体建议。拟议的研究将提供关于MD<65作为一个整体的关键信息，以及健康和心理健康共病如何累积和影响每组健康结果差异的发展。

 DESCRIPTION (provided by applicant): Disabled persons under the age of 65 who qualify for Medicare (MD<65) appear to have unique challenges in obtaining health care, poor health outcomes, and high costs of care although research on the population remains limited. Comorbid and serious mental illness appears to strengthen the association between disability and poor health outcomes. This study addresses the effects of disability and comorbid mental illness of the MD<65 by examining self-care capacity, its relationship to health status, and over a 14-year period, to selected illness trajectories and health outcomes, considering community capacity to support health, quality of health care, and intersecting effects of gender, race, and rurality. The health care experiences of three groups of the MD<65 will be compared: the physically disabled (PHYS), physically disabled with co-morbid mental disorders (CMD), and seriously mentally ill disabled (SMI) and then contrasted with Medicare recipients 65 and older. The study design and analyses are guided by an empirically supported multi-factorial health outcomes model developed by the two PIs. Investigators will use the Medicare Current Beneficiary Survey (MCBS) and Medicare Claims data (MCD) employing multilevel analyses, will first examine the influence of community capacity on self-care capacity and health status for 47,680 Medicare recipients, MD<65 with PHYS, CMB, and SMI contrasted with MD>65. Next, detailed 14-year longitudinal profiles of received health care will be constructed for those with cardiovascular disease (CVD) and diabetes mellitus (DM), co-morbidities prevalent in the disabled. Employing a longitudinal, population analytic design investigators will estimate survival on health/illness trajectories for selected outcomes including mortality in each group. At each level of analysis investigators will also examine the influence of gender, race, and rurality to assess the extent to which intersecting effects of each identity further affect morbidity and mortality disparities seen. The aggregation of Medicare claims data with other datasets we will use in the proposed research will enable us to identify community level and health system factors that contribute to worsening health, increased utilization, and high health care costs which, in turn will enable investigators to make specific recommendations for individual and system level health care interventions. The proposed research will provide key information about MD<65 as a whole and how health and mental health comorbidities accrue and influence the development of disparities in health outcomes in each group.