Improving Minority Health by Monitoring Medicaid Quality, Disparities and Value

项目总结 精神分裂症是一种严重的精神疾病，由于严重的残疾和 过早死亡在很大程度上是由共同发生的慢性疾病导致的，这些疾病使预期寿命缩短了 至少20年。这些人口所需的广泛服务主要由医疗补助提供。 尽管费用很高，但大多数患者没有得到推荐的治疗，少数族裔不太可能这样做 而不是白人。这些先前存在的差距和深刻的社会劣势也经历了 人口使他们特别容易受到新冠肺炎大流行造成的破坏， 美国在纽约州的情况尤其严重。患有精神分裂症的纽约人和少数族裔 特别是，他们不仅是新冠肺炎结局较差的高危群体，而且他们可能还会经历 由于他们获得医疗保健的能力受到干扰，他们的健康状况有所下降。尽管纽约的医疗补助计划 在州长宣布一个州之后不久，该计划授权使用远程医疗来减轻这些干扰 2020年3月初的紧急情况，医疗补助提供者采用远程医疗的程度 为严重精神病患者提供服务以及远程保健收养的效果是否会因种族/民族而异 并不广为人知。我们建议的行政补充应用程序建立在我们正在进行的NIMHD资助的基础上 家长研究(MD012428)，旨在减少医疗保健差距，从而改善 通过衡量质量差距和价值(或成本效益)来衡量种族/少数民族人口 为患有精神分裂症的成年人提供医疗补助资助的护理。与NIMHD的通知一致 特别关注呼吁研究新冠肺炎爆发对健康差距人群的影响，我们 建议评估疫情对种族/族裔多样化的医疗补助人口的影响 居住在纽约的精神分裂症受益人。在目标1中，我们将评估疫情对 提供给我们的精神和身体保健的机会、质量和有效性方面的种族/民族差异 研究人口。在目标2中，我们将评估医疗补助提供者对疫情的反应及其对 我们研究人群中的医疗保健差距。我们将通过以下衡量标准来描述提供商的响应 提供商已准备好采用远程医疗。我们评估疫情影响的一般方法 医疗保健结果以及提供者的反应对这些结果的影响将涉及使用后预置 疫情差异、中断的时间序列方法以及利用时变的方法 系数。在所有分析中，我们主要感兴趣的是描述种族/民族如何调节 疫情对结果的影响以及提供者对结果的反应。我们期待我们的工作将提供 政策制定者更好地了解疫情对弱势群体的影响，并使 制定更有效的政策来应对当前和未来的危机。

PROJECT SUMMARY Schizophrenia is a serious mental illness associated with a high burden of disease due to severe disability and premature mortality largely driven by co-occurring chronic medical conditions that shorten life expectancy by at least 20 years. The broad array of services needed by this population are primarily financed by Medicaid. Despite high costs, most patients do not receive recommended care, and minorities are less likely to do so than whites. These pre-existing disparities and the profound social disadvantage also experienced by this population make them particularly vulnerable to the devastation caused by the COVID-19 pandemic, which in the US has been particularly severe in the state of New York. New Yorkers with schizophrenia, and minorities in particular, are not only a high-risk group for poorer COVID-19 outcomes but they may also experience declines in their health due to disruptions in their ability to access healthcare. Although New York’s Medicaid program authorized the use of telehealth to mitigate those disruptions soon after the Governor declared a State of Emergency in early March 2020, the degree to which telehealth has been adopted by Medicaid providers serving seriously mentally ill people and whether the effects of telehealth adoption may vary by race/ethnicity are not well known. Our proposed administrative supplement application builds on our ongoing NIMHD-funded parent study (MD012428), which seeks to reduce healthcare disparities and thus improve health outcomes of racial/ethnic minority populations through measurement of quality disparities and value (or cost-effectiveness) of Medicaid-financed care delivered to adults with schizophrenia. Consistent with the NIMHD’s Notice of Special Interest calling for studies of the impact of the COVID-19 outbreak on health disparity populations, we propose to evaluate the effects of the outbreak on the racially/ethnically diverse population of Medicaid beneficiaries with schizophrenia living in New York. In Aim 1, we will assess the effect of the outbreak on racial/ethnic disparities in access, quality, and effectiveness of mental and physical healthcare delivered to our study population. In Aim 2, we will assess Medicaid providers’ responses to the outbreak and their effects on healthcare disparities in our study population. We will characterize provider response through a measure of provider readiness to adopt telehealth. Our general approach to assessing the impact of the outbreak on healthcare outcomes and the impact of provider responses on those outcomes will involve the use of post-pre outbreak differences, interrupted time series approaches, as well as approaches that utilize time-varying coefficients. In all analyses, our primary interest are parameters that describe how race/ethnicity moderates the outbreak’s effect on outcomes and the providers’ responses on outcomes. We expect that our work will provide policymakers with a better understanding of the impacts of the outbreak on vulnerable populations and enable the design of more effective policies to address this and future crises.