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

当地卫生部门对精神健康障碍患者医疗保健差异的影响

• 批准号: 9034884
• 负责人: Jie Chen
• 金额: $ 22.33万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-01-01 至 2017-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9034884
• 关键词: Affect; African American; Area; Belief; Caring; Cessation of life; Chronic; Chronic Disease; Communities; Community Health; Comorbidity; County; Data; Data Set; Diabetes Mellitus; Disease; Disease Progression; Face; Goals; Health; Health Promotion; Health Services Accessibility; Health education; Health system; Healthcare; Healthy People 2020; Heart Diseases; Home environment; Individual; Investigation; Knowledge; Latino; Leadership; Low income; Maryland; Medical; Mental Health; Mental disorders; Minority; Mission; Modeling; Outcome; Patients; Play; Population; Psyche structure; Research; Resources; Risk; Role; Services; Severities; Source; Stigmatization; Strategic Planning; System; Techniques; Testing; Trust; United States Substance Abuse and Mental Health Services Administration; Vulnerable Populations; base; behavioral health; burden of illness; community center; cost effectiveness; disparity reduction; ethnic minority population; health care delivery; health care disparity; health care model; health disparity; improved; innovation; insight; mental health related disorder; mortality; mortality disparity; patient oriented; primary care setting; programs; psychologic; public health relevance; racial and ethnic disparities; racial disparity; racial minority; sound; success

 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.

 描述（由申请人提供）：与白人相比，非洲裔美国人和拉丁裔美国人获得的精神卫生保健机会较少，并且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 会导致高死亡率、增加患心脏病和糖尿病等主要慢性疾病的风险，并加速疾病进展。有证据表明，通过整合个人和组织因素，改善患有 MHD 和其他疾病的患者的医疗保健具有成本效益，但我们在如何最好地实现地方卫生部门 (LHD) 与其所服务的社区的整合方面仍然存在知识空白。本研究的目的是确定有效的 LHD 活动，以减少 MHD 患者（包括那些患有 MHD 的患者）医疗保健方面的种族和民族差异 患有 MHD 和并存的慢性疾病。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。我们的假设基于一个生态模型，该模型表明 LHD 可以通过向医疗保健机会有限的人提供关键的医疗保健资源并促进反映社区健康需求的健康教育和患者参与来减少 MHD 患者的医疗保健差异。由于 LHD 在服务不足的地区承担更多责任，并为弱势群体提供医疗保健的主要来源，因此患有 MHD 的少数族裔患者可能会从 LHD 活动中获得更多利益。具体来说，我们将评估 LHD 活动对 MHD 患者医疗保健的影响（目标 1），以及 LHD 活动对精神卫生保健中种族和民族差异（非裔美国人与白人；拉丁裔与白人）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 活动对患有 MHD 和其他慢性疾病（如糖尿病和心脏病）的个体的一般医疗保健中的种族和民族差异的影响（目标 3）。我们将收集多年来独特的多级（个人、LHD、县和州）数据集 2004-2014 年，并采用多级/分层估计、双重差分分析和分解技术来量化 LHD 活动对减少 MHD 患者医疗保健中的种族和民族差异的贡献。本次探索性成果 研究将产生大量新的证据和见解，涉及如何利用 LHD 的资源来整合对 MHD 患者的护理，以及在多大程度上可以使用或应该扩大 LHD 的资源来改善心理健康。这项研究的结果将提供建立更全面、更有力的调查所需的初步数据，以估计 LHD 对健康结果中种族和民族差异的影响，并开发一个科学合理且适合文化的 LHD 综合医疗保健模式，该模式将改善 LHD 的健康状况。 提高医疗保健服务系统的效率，并有可能加速可持续努力，以减少并最终消除 MHD 患者的健康差距。