Physician Referral & Mental-Disorder Related Disparities in CABG Quality

描述(由申请人提供)：内科或外科并存的精神障碍患者在获得适当的医疗保健，特别是高质量的心脏服务方面面临着巨大的障碍。有证据表明，在急性心肌梗死后，精神障碍患者倾向于使用包括冠状动脉旁路移植(CABG)手术在内的侵入性心脏手术。此外，我们最近的工作表明，患有精神障碍(如精神障碍或药物滥用障碍)的患者，当他们接受CABG手术时，更有可能接受护理质量较差的心脏外科医生的治疗。由于超过25%的老年人患有精神障碍，而冠心病(CHD)是这一群体医疗发病率和死亡率的主要原因之一，与精神障碍相关的心脏血管重建术的质量差异尤其令医疗保险人群感到担忧。此外，每年超过50%的CABG手术是在65岁及以上的个人身上进行的。然而，对于并存精神障碍患者接受CABG手术质量差异背后的原因，人们知之甚少。精神障碍患者是一个医学上的弱势群体，越来越多地被证明受到不适当的内外科治疗。这项研究的目的是通过对医生将患者转至CABG手术的行为的检查，帮助理解导致这些观察到的差异的原因以及相关的临床和政策含义。我们将分析联邦医疗保险索赔数据，以检查实际的医生实践，其中将比较医生在转诊患有和不患有精神障碍的冠心病患者时的行为。将采用多元统计回归分析。这项研究的结果将有助于设计未来的研究，旨在为有效的政策和实践倡议提供信息，以消除老年精神障碍患者面临的差异，并使政策制定者更好地武装起来，以解决向脆弱的精神病患者提供医疗护理方面的问题。 公共卫生相关性：这项拟议的项目旨在研究转诊医生在冠心病医疗保险患者在接受高质量心脏手术方面与精神障碍相关的差异中所扮演的角色。

DESCRIPTION (provided by applicant): Medical or surgical patients with coexisting mental disorders face significant barriers to accessing appropriate health care in general, and high quality cardiac services specifically. Evidence suggests that after acute myocardial infarction, patients with mental disorders tend to under-use invasive cardiac procedures including coronary artery bypass graft (CABG) surgery. In addition, our recent work shows that patients with mental disorders (such as psychiatric disorders or substance abuse disorders), when they do receive CABG surgery, are more likely to be treated by cardiac surgeons of inferior quality of care. The mental-disorder related disparities in quality of cardiac revascularization surgery are of particular concern for the Medicare population, as over 25% older persons are suffering mental disorders, and coronary heart disease (CHD) is one of the major causes of medical morbidity and mortality in this population. In addition, over 50% of all CABG surgeries are performed each year on individuals age 65 and over. However, relatively little is known about the dynamics underlying the disparity in quality of CABG surgery received by patients with coexisting mental disorders, a medically vulnerable group who has increasingly been shown to suffer from inappropriate medical and surgical care. The purpose of the study is to contribute to the understanding of the causes that lead to these observed disparities and the related clinical and policy implications, through an examination of physician behaviors in referring patients to CABG surgery. We will analyze Medicare claims data to examine actual physician practices, in which physician behavior in referring CHD patients with and without mental disorders will be compared. Multivariate statistical regression analyses will be employed. Findings of this study will help the design of future studies that aim to inform effective policy and practice initiatives to eliminate the disparities faced by elderly patients with mental disorders and better equip policy makers to address problems in the delivery of medical care to the vulnerable, mentally ill patients. PUBLIC HEALTH RELEVANCE: This proposed project was designed to examine the role of referring physicians in the mental-disorder related disparities in receipt of high-quality cardiac procedures among Medicare patients with coronary heart diseases.