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，非洲裔美国人和拉美裔美国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)治疗方面面临严重的污名。未经治疗的多发性硬化症死亡率高，罹患包括心脏病和糖尿病在内的重大慢性病的风险增加，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，但对于如何最好地实现地方卫生部门(LHD)与其服务的社区的整合，我们的知识仍然存在差距。这项研究目的是确定有效的LHD活动，以减少MHD患者在医疗保健方面的种族和民族差异，包括 患有多发性硬化症和共存的慢性病。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。我们的假设基于一个生态模型，该模型表明，LHDs可以通过向卫生保健机会有限的人提供关键的卫生保健资源，以及促进反映社区卫生需求的健康教育和患者参与来减少MHD患者的卫生保健差距。由于LHD在服务不足的地区承担了更多的责任，并为弱势人群提供了主要的医疗保健，因此患有MHD的种族和少数民族患者可能会从LHD活动中获得更多好处。具体地说，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方面的种族和民族差异(非洲裔美国人与白人；拉丁裔与白人)的影响(目标2)。鉴于多发性硬化症是主要慢性疾病的常见并存，我们将评估LHD活动对患有多发性硬化症和其他慢性疾病(如糖尿病和心脏病)的个人在一般医疗保健方面的种族和民族差异的影响(目标3)。我们将收集多年来唯一的多层次(个人、LHD、县和州)数据集 2004年至2014年，并采用多层次/等级估计、差异差异分析和分解技术，量化土地和发展活动对减少多民族发展个人在医疗保健方面的种族和族裔差异的贡献。这次试探的结果 这项研究将产生大量新的证据和见解，说明如何利用LHD的资源将对个人的护理与MHD结合起来，以及LHD的资源可以在多大程度上被使用或应该被扩大，以改善精神健康。这项研究的结果将提供所需的初步数据，以建立更全面和强有力的调查，以估计LHD对种族和民族健康结果差异的影响，并开发科学合理和文化定制的LHD综合保健模式，将改善 提高医疗保健提供系统的效率，并有可能加快可持续努力，以减少并最终消除多发性硬化症患者的健康差距。

 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.