Understanding Mechanisms of Mental Health Care Disparities

描述（由申请人提供）：本提案有两个主要目标：1）开发一个用于州精神卫生保健报告卡的精神卫生保健差异指数; 2）使用网络交互式地图传播该指数的结果，并从州政策制定者那里获得关于演示和结果的初步反馈。有必要制定一个基于国家的精神卫生保健差距指数，以改善从研究到政策的翻译与一个简洁，易于使用的工具，用于评估和跟踪差距。然而，在将多个差距衡量标准简化为一个数字方面出现了困难，包括确定差距指标的最佳权重和选择确定国家在减少差距方面成功与否的阈值。我们首先使用来自政策制定者，倡导者和临床医生的定性访谈的信息，以引出最突出的结构和变量被纳入指数。然后，我们开发了一个指数，采用现代测试理论方法（验证性因素分析和潜变量建模），结合了六个指标的精神卫生保健的启动，支出和质量差异，同时优化的内部和外部效度的指数。我们使用贝叶斯小区域估计和分层模型，以克服小样本量和嵌套数据使用限制和公共使用的数据，从2004-2009年医疗支出面板调查。为了确保广泛的传播和使用，我们提出的结果，使用交互式地图，允许国家一级的差距指数组件数据的演示和操纵。将从州政策制定者那里得到反馈，以更好地了解他们对该指数的介绍和结果的反应，以及他们对该州精神卫生保健差异气候背后机制的解释。 公共卫生相关性：在这个项目中，我们开发了一个差异指数，以创建一个州际精神卫生保健差异报告卡。我们的目标是开发一个指数/报告卡，这是显着的，并有政策制定者和倡导者的表面有效性，同时得到严格的定量和定性方法的支持。报告卡的编制方法主要采用小面积估计法和现代测验理论方法，并辅以关键信息人访谈。关于拟议项目的第二部分，我们的重点是分发索引/报告卡，利用一个可上网的地理信息系统装置，以方便查阅和互动的方式提供信息。指数/报告卡的结果和介绍将显示给国家精神卫生主任的反馈，并告知未来的发展方向的指数和了解政策机制的精神卫生保健的差距。

DESCRIPTION (provided by applicant): There are two main objectives of this proposal: 1) to develop a mental health care disparities index to be used in state mental health care report cards; and 2) to disseminate the results of the index using web-enabled interactive maps and receive initial feedback on the presentation and results from state policymakers. There is a need for developing a state-based mental health care disparities index to improve translation from research to policy with a concise, readily useable tool for assessing and tracking disparities. However, difficulties arise in reducing multiple disparities measures into a single number, including identifying the optimal weighting of disparities indicators and the choice of thresholds determining states' success in reducing disparities. We first use information from qualitative interviews of policymakers, advocates and clinicians to elicit the most salient constructs and variables to be included in the index. We then develop an index using modern test theory methods (confirmatory factor analysis and latent variable modeling) that combines six indicators of mental health care initiation, expenditure, and quality disparities while optimizing the internal and external validity of the index. We use Bayesian small area estimation and hierarchical modeling to overcome small sample sizes and nested data using restricted and public use data from the 2004-2009 Medical Expenditure Panel Survey. To ensure wide dissemination and use, we present results using interactive maps that allow for the presentation and manipulation of state-level disparities index component data. Feedback from state policymakers will be elicited to better understand their reactions to the presentation and the results of the index and their interpretation of the mechanisms underlying the mental health care disparities climate in their state. PUBLIC HEALTH RELEVANCE: In this project, we develop a disparities index to create a state-by-state mental health care disparities report card. We aim to develop an index/report card that is salient and has face validity for policymakers and advocates, while being backed by rigorous quantitative and qualitative methods. The methods used to develop the report card are small area estimation and modern test theory methods enhanced by key informant interviews. For the second part of the proposed project, we focus on the dissemination of the index/report card, using a web-enabled geographic information systems setup to present information in an easily accessible and interactive manner. The results and presentation of the index/report card will be shown to state mental health directors for feedback and to inform future directions in the development of the index and in understanding policy mechanisms underlying mental health care disparities.