Using Medicaid data to advance care for people with schizophrenia at risk for HIV (Medicaid-DASH)

项目总结/摘要 患有严重精神疾病的人（例如，精神分裂症，双相情感障碍; SMI）是一个社会边缘化的 被诊断为艾滋病毒感染的可能性比一般人群高出10倍 美国人口。父母补助金（R 01-MH 112420）旨在调查增加的艾滋病毒 传播风险，低检测率和潜在的艾滋病毒治疗缺口， 地理上不同的国家纵向回顾性医疗补助队列。评估的结果 但是，父母补助金可能因其属于交叉的社会边缘化类别而有所改变。 不考虑弱势群体异质性的单轴干预措施可能不会 有效地改善结果和实现流行病控制。因此，需要进行研究， 评估风险最大的交叉职位之间结果不平等的程度。 利用12年的医疗补助数据（2001年至2012年），本研究的主要目标是评估 在艾滋病毒连续护理过程中，在交叉护理方面，结果不平等的存在和程度 社会边缘化的类别（如精神分裂症诊断、种族/民族、性别、静脉注射毒品使用， 等）。多样性补充材料旨在为非政府组织提供有指导的理论和方法培训， 在数量交叉性研究领域的候选人。建议的职业发展目标是：（1） 发展交叉性的基础知识作为理论框架;（2）发展专业知识 量化交叉性研究方法。为配合职业发展目标， 本研究的研究目标是：（a）研究前沿的定量交叉性 评估艾滋病毒结果不平等的存在和程度的方法， 数据库;（B）通过精神分裂症诊断的交叉类别检查HIV测试的差异率， R 01父母补助回顾性队列中的性别、年龄、静脉吸毒史和人种/种族;以及 (c)通过精神分裂症诊断、性别、 R 01父母资助回顾性队列中的年龄、静脉药物使用史和种族/民族。的 从这项工作中产生的证据可以确定最危险的交叉位置，以告知目标，成本， 有效的干预措施，以改善最脆弱人群的艾滋病毒检测和护理结果。此外，本发明还 交叉性的基础知识作为一个理论框架，与应用配对， 量化交叉方法，以一个大的行政数据集，将定位候选人有一个 作为一名独立调查员的有影响力的职业生涯，产生严格的定量证据，证明 社会边缘化人群的健康不平等。

PROJECT SUMMARY/ABSTRACT People with severe mental illness (e.g., schizophrenia, bipolar disorder; SMI) are a socially marginalized population with up to ten times increased likelihood of being diagnosed with HIV compared to the general United States population. The parent grant (R01-MH112420) aims to investigate the increased HIV transmission risk, low testing rate, and potential HIV treatment gaps for people with SMI using a large, geographically diverse national retrospective longitudinal Medicaid cohort. The outcomes assessed by the parent grant, however, may be modified by membership in intersecting categories of social marginalization. Single-axis interventions that do not consider heterogeneities among vulnerable populations may not be effective in improving outcomes and achieving epidemic control. Therefore, research is needed to identify and assess the magnitude of outcome inequalities among the riskiest intersectional positions. Leveraging twelve years of Medicaid data (2001 through 2012), the major goal of this research is to assess the existence and magnitude of outcome inequalities along the HIV continuum of care, with respect to intersecting categories of social marginalization (e.g. schizophrenia diagnosis, race/ethnicity, sex, intravenous drug use, etc.). The diversity supplement seeks to provide mentored theoretical and methodological training for the candidate in the area of quantitative intersectionality research. The proposed career development aims are: (1) to develop foundational knowledge in intersectionality as a theoretical framework; and (2) to develop expertise in quantitative intersectionality research methods. Aligned with the career development objectives, the research goals of the proposed study are to: (a) research the cutting-edge quantitative intersectionality approaches to assess the existence and magnitude of HIV outcome inequalities within a large administrative database; (b) examine differential rates of HIV testing by intersecting categories of schizophrenia diagnosis, sex, age, history of intravenous drug use, and race/ethnicity in the R01 parent grant retrospective cohort; and (c) examine differential rates of treatment for HIV by intersecting categories of schizophrenia diagnosis, sex , age, history of intravenous drug use, and race/ethnicity in the R01 parent grant retrospective cohort. The evidence generated from this work could identify the riskiest intersectional positions to inform targeted, cost- effective, interventions to improve HIV testing and care outcomes among those most vulnerable. Additionally, the foundational knowledge of intersectionality as a theoretical framework, paired with the application of quantitative intersectionality methods to a large administrative data set, will position the candidate to have an impactful career as an independent investigator generating rigorous quantitative evidence demonstrating health inequities among socially marginalized populations.