Organizational Capacity to Eliminate Outcome Disparities under Healthcare Reform

描述(由申请人提供)：药物滥用治疗领域在减少种族和少数民族人口之间的健康差距方面面临着前所未有的挑战。获得药物滥用、心理健康和艾滋病毒预防综合护理与积极的健康结果和降低成本相关。这项拟议研究的总体目标是确定《平价医疗法案》(ACA)引发的变化如何影响以社区为基础的门诊药物滥用治疗(OSAT)计划的能力，以扩大种族和少数民族社区的服务提供，并消除非洲裔美国人和拉美裔客户之间的结果差异。此应用程序的目标是通过开发和分析小组数据集，检查当前医疗补助计划的扩大对基于社区的OSAT计划的能力的组织影响，以加强居住在加利福尼亚州洛杉矶县(洛杉矶)的少数族裔获得治疗和保留治疗的机会。我们的概念框架以组织发展框架为基础，调查了组织能力(即领导力、变革准备情况、中期结算)在调解 扩大医疗补助(在加利福尼亚州称为Medi-Cal)对服务提供(即精神卫生)的影响 卫生和艾滋病毒预防服务)以及非洲裔美国人和拉丁裔客户的治疗、获得和保留。在目标1和目标2中，我们将检查基线数据，以完善我们的组织能力因素的概念模型，这些因素可能会影响在ACA颁布之前，在种族和少数民族社区的OSAT项目中提供心理健康和艾滋病毒预防服务。我们将在2013年、2015年和2017年重新调查位于少数族裔社区的147个具有代表性的OSAT项目样本，以形成一个面板数据集。这些项目数据的重复测量将与每个数据点的行政客户结果数据(N~10,800名客户)连接在一起，以在目标3和4中检查保险扩展对少数族裔社区服务提供的纵向影响，以及有心理健康和艾滋病毒风险状况的非裔美国人和拉丁裔客户的获得和留存率。拟议研究的总体公共卫生影响包括在公共资助的基于社区的OSAT计划中确定有希望的组织因素，这些计划服务于很大一部分低收入少数族裔客户，这些客户在ACA保险扩展和以客户为中心的流程结果之间发挥调解作用，目标是消除健康差距。

DESCRIPTION (provided by applicant): The substance abuse treatment field faces an unprecedented challenge to reduce health disparities among racial and ethnic minority populations. Access to integrated substance abuse, mental health, and HIV prevention care is associated with positive health outcomes and reduced cost. The overall goal of the proposed study is to identify how changes precipitated by the Affordable Care Act (ACA) impact community- based outpatient substance abuse treatment (OSAT) program capacity to expand service delivery in racial and ethnic minority communities and eliminate outcome disparities among African American and Latino clients. The objective for this application is to examine the organizational impact of the current expansion of Medicaid on the capacity of community-based OSAT programs to enhance treatment access and retention among minorities residing in Los Angeles County (L.A.), California by developing and analyzing a panel dataset. Our conceptual framework, grounded in organizational development frameworks investigates the role of organizational capacity (i.e., leadership, readiness for change, Medi-Cal billing) in mediating the effect of Medicaid expansion (referred as Medi-Cal in California) on service delivery (i.e., mental health and HIV prevention services) and on treatment access and retention among African American and Latino clients. In Aim 1 and 2 we will examine baseline data to refine our conceptual model of organizational capacity factors likely to impact the delivery of mental health and HIV prevention services in OSAT programs in racial and ethnic minority communities, prior to ACA enactment. We will resurvey in 2013, 2015 and 2017 the same representative sample of 147 OSAT programs located in minority communities to form a panel data set. These repeated measures of program data will be concatenated with administrative client outcome data (N~10,800 clients) at each data point to examine in Aims 3 and 4 the longitudinal impact of insurance expansion on service delivery in minority communities and rates of access and retention among African American and Latino clients with mental health and HIV risk conditions. The overall public health impact of the proposed study includes identifying promising organizational factors among publicly funded community-based OSAT programs that serve large proportions of low-income minority clients that play a mediating role between the ACA insurance expansion and client-centered process outcomes with the goal of eliminating health disparities.