Effect of Local Health Departments on Health Care Disparities for Individuals with Mental Health Disorders

 描述（由申请人提供）：与白人相比，非洲裔美国人和拉丁美洲人获得精神卫生保健的机会较少，在寻求和接受精神健康障碍（MHD）治疗时面临严重的耻辱。未经治疗的MHD与高死亡率，发展主要慢性疾病（包括心脏病和糖尿病）的风险增加以及加速疾病进展有关。证据表明，通过整合个人和组织因素，改善MHD和其他疾病并存的患者的医疗保健的成本效益，但我们对如何最好地实现地方卫生部门（LHD）与他们所服务的社区的整合的知识仍然存在差距。本研究的目的是确定有效的LHD活动，减少MHD患者在医疗保健方面的种族和民族差异，包括 MHD和共存的慢性病。我们的中心假设是，LHD的服务提供和健康促进可以减少差距。我们的假设是由一个生态模型表明，LHD可以减少个人与MHD的医疗保健差距，提供关键的医疗保健资源，以有限的医疗保健服务的人，促进健康教育和病人的参与，反映社区的健康需求。由于LHD在服务不足的地区承担更多的责任，并为弱势群体提供医疗保健的主要来源，种族和少数民族MHD患者可能会从LHD活动中获得更多的好处。具体而言，我们将评估LHD活动对MHD患者的医疗保健的影响（目标1），以及LHD活动对精神卫生保健中种族和民族差异（非裔美国人与白色;拉丁美洲人与白色）的影响（目标2）。鉴于MHD是主要慢性疾病的常见合并症，我们将评估LHD活动对MHD和其他慢性疾病（如糖尿病和心脏病）共存个体的一般医疗保健中种族和民族差异的影响（目标3）。我们将收集一个独特的多层次（个人，LHD，县和州）数据集的年 2004-2014年，并采用多层次/层次估计，差异中的差异分析和分解技术来量化LHD活动对减少MHD患者医疗保健中种族和民族差异的贡献。这次探索的结果 这项研究将产生大量新的证据和见解，说明如何利用LHD的资源来整合对MHD患者的护理，以及LHD的资源可以或应该在多大程度上用于改善心理健康。这项研究的结果将提供初步数据，以建立一个更全面和强大的调查，以估计LHD对种族和民族差异的影响，在健康结果，并制定一个科学合理的和文化定制的LHD整合的医疗保健模式，将改善 提高医疗保健提供系统的效率，并可能加快可持续的努力，以减少并最终消除MHD患者的健康差距。

 DESCRIPTION (provided by applicant): African Americans and Latinos have less mental health care access and face substantial stigmatization in seeking and receiving treatment for mental health disorders (MHDs), compared to Whites. Untreated MHDs are associated with high mortality rates, increased risks of developing major chronic diseases, including heart disease and diabetes, and accelerating disease progression. Evidence demonstrates the cost effectiveness of improving health care for patients with coexisting MHDs and other diseases through the integration of individual and organizational factors, yet there remains a gap in our knowledge about how to best accomplish the integration of Local Health Departments (LHDs) with the communities they serve. The objective of this study is to identify effective LHD activitie that reduce racial and ethnic disparities in health care for individuals with MHDs, including those with MHDs and coexisting chronic diseases. Our central hypothesis is that LHDs' service provision and health promotion can reduce disparities. Our hypothesis is informed by an ecological model demonstrating that LHDs can reduce health care disparities for individuals with MHDs by providing critical health care resources to people with limited health care access and promoting health education and patient engagement that reflect community health needs. Since LHDs assume more responsibilities in underserved areas and provide a major source of health care for vulnerable populations, racial and ethnic minority patients with MHDs may gain more benefit from LHD activities. Specifically, we will assess the effect of LHD activities on health care for individuals with MHDs (Aim 1), and the effect of LHD activities on racial and ethnic disparities (African American vs. White; Latino vs. White) in mental health care (Aim 2). Given that MHDs are common comorbidities of major chronic diseases, we will assess the effect of LHD activities on racial and ethnic disparities in general health care for individuals with coexisting MHDs and other chronic diseases, such as diabetes and heart disease (Aim 3). We will assemble a unique multi-level (individual-, LHDs-, county-, and state-) data set for the years 2004-2014, and employ multi-level/hierarchical estimation, difference-in-differences analysis, and decomposition technique to quantify the contribution of LHDs' activities to the reduction of racial and ethnic disparities in health care for individuals with MHDs. Results of this exploratory study will generate substantial amounts of new evidence and insights about how to utilize LHDs' resources to integrate the care for individuals with MHDs, and to what extent the resources of LHDs can be used, or should be expanded, to improve mental health. Results of this study will provide preliminary data needed to build a more comprehensive and robust investigation to estimate the impact of LHDs on racial and ethnic disparities in health outcomes, and develop a scientifically sound and culturally tailored LHD-integrated health care model that will improve the efficiency of the health care delivery system and potentially accelerate sustainable efforts to reduce and ultimately eliminate health disparities for individuals with MHDs.