Effects of Hospital-Community-Public Health Integration on Racial and Ethnic Disparities in Mental Health

总结 精神疾病是美国主要的公共卫生问题，也是发病率和死亡率的重要来源。 种族和少数民族患者经历不成比例的负担，共同的身体健康状况 这主要是由于缺乏医疗保健和社会耻辱。有效 治疗精神疾病和相关疾病将取决于一种全面的方法， 卫生系统和政策，如社区福利州法律，以“人口健康”为目标， 强调健康的社会决定因素的价值。然而，目前的精神卫生保健系统在 一个筒仓，缺乏保健协调对健康差距的证据。这项研究的目的是检查 医院，社区和公共卫生机构之间的系统级护理协调，并估计其 对非裔美国人和拉丁美洲精神疾病患者未满足的医疗保健需求的影响。的理由 对于所提议的研究是，一旦知道什么具体的协调实践（例如，医疗服务， 交通、公共住房）和政策对不同的患者人群最为成功， 精神和身体保健提供系统可以设计在一个更具成本效益的方式，以克服 污名化和有限的医疗保健服务的障碍。在这个项目中，我们将首先确定 社区福利州法律关于种族和族裔之间在获得医疗保健、质量和费用方面的差异 精神疾病患者（目标1）。在此背景下，我们将进一步确定医院为基础的变化 护理协调实践的采用及其与患者和社区层面社会 人口统计、当地公共卫生资源和社区福利法的实施程度 (Aim 2）;并确定医院，社区和公众之间的护理协调实践的影响 卫生机构关于种族和族裔健康差距的报告（目标3）。我们将使用混合方法：（1）我们将 建立一个多层次的数据集，将多个具有国家代表性的数据集联系起来， 采用差异方法估计系统一级护理协调对不同种族/族裔群体的影响; 和（2）我们将调查的挑战，实施系统级协调使用焦点小组的种族 和少数民族患者代表，医院管理人员和供应商，以及来自 公共卫生机构。拟议的研究是重要的，因为（1）确定的做法预计将 提供关于如何为种族和少数民族患者提供个性化精神卫生保健协调的证据 解决心理健康治疗中的异质偏好;（2）确定系统级护理协调 预计这些做法将具有成本效益，这反过来又可以使协调工作可持续， 服务不足的人群。我们的研究结果有望打破长期存在的孤岛，弥合差距 在卫生保健提供者、社区组织、社会服务机构和公共卫生之间， 此外，还为通过护理协调减少健康差距提供证据。

Summary Mental illness is a major public health concern in the U.S. and a significant source of morbidity and mortality. Racial and ethnic minority patients experience disproportionate burdens of common physical health conditions associated with mental illness, largely due to the lack of health care access and social stigma. Effectively treating mental illness and the associated conditions will depend on a comprehensive approach that crosses health systems and policies, such as the Community Benefit State Laws, to target “Population Health” and emphasize the value of social determinants of health. However, the current mental health care system works in a silo, and evidence of care coordination on health disparities is lacking. The goal of this study is to examine system-level care coordination among hospitals, communities, and public health agencies, and to estimate its impacts on unmet health care needs in African American and Latino patients with mental illness. The rationale for the proposed research is that once it is known what specific coordination practices (e.g. medical services, transportation, public housing) and policies are most successful for different patient populations, integration of mental and physical health care delivery systems can be designed in a more cost-effective way to overcome the barriers from stigma and limited health care access. In this project, we will first determine the effects of Community Benefit State Laws on racial and ethnic disparities in health care access, quality, and costs among people with mental illness (Aim 1). Within this context, we will further identify the variation of hospital-based adoption of care coordination practices and its correlation with patient and community level socio- demographics, local public health resources, and the extent of the implementation of community benefit laws (Aim 2); and determine the impact of care coordination practices between hospitals, communities, and public health agencies on racial and ethnic health disparities (Aim 3). We will use mixed methods: (1) we will construct a multi-level data set by linking multiple nationally representative data sets and use difference-in- differences approach to estimate the impact of system-level care coordination on different racial/ethnic groups; and (2) we will investigate challenges to implementing system-level coordination using focus groups of racial and ethnic minority patient representatives, hospital administrators and providers, and representatives from public health agencies. The proposed research is significant because (1) identified practices are expected to provide evidence on how to personalize mental health care coordination for racial and ethnic minority patients to address heterogeneous preferences in mental health treatment; (2) identified system-level care coordination practices are expected to be cost-effective, which in turn can make the coordination sustainable for underserved populations. Our results are expected to break down longstanding silos and bridge the gap between health care providers, community based organizations, social service agencies, and the public health sector delivery system, in addition to providing evidence to reduce health disparities through care coordination.