Does Access to Patient Centered Medical Home reduce Racial and Ethnic Disparities in the care for Pediatric Major Depressive Disorders?

项目摘要： 尽管受到全国的关注，但青少年精神卫生保健方面的种族/族裔差异仍然很大，而且持续存在 缩小差距。来自少数种族/族裔群体的青年大约有三分之一到一半的可能性 作为白色青年接受心理健康护理。差距不仅存在于最初获得护理的机会， 服务完成和质量。在获得护理和护理质量方面的这些差异可能会导致更大的 2006年非裔美国人和拉丁美洲人精神障碍的持续性、严重性和疾病负担 成年由于儿童和青少年精神科医生严重短缺，初级保健机构 成为所有有行为问题的儿童和青少年的第一接触点和治疗场所。 以病人为中心的医疗之家（PCMH）已被证明是一个有前途的模式，以授权 初级保健提供者对儿童精神障碍进行筛查、治疗和监测。然而，在这方面， 它对解决不平等问题的影响尚未得到直接评估。拟议研究的目标 是检查是否可以通过任何一种服务获得带有综合行为服务的PCMH 托管或远程精神病学，可以弥补儿童重度抑郁症护理的差异 （MDD）。与德克萨斯州东南部最大的医疗补助管理式医疗计划之一合作， 超过400，000名儿科注册者，我们将联合收割机结合最新的医疗补助索赔数据（2013-16）， 提供者的特点和系统因素，如实践设置，实践规模和地理位置。 将根据地理编码确定服务托管，并确定远程精神病学的使用 使用当前程序术语代码。我们的目标是：一。研究将PCMH作为 “通常的护理提供者”对MDD的识别，并评估其与种族/民族的关联 MDD诊断率的差异; II.比较MDD患者接受MDD治疗的可能性， 病例首次诊断在PCMH与传统的初级保健，并评估其与 MDD治疗率的种族/民族差异; III.为了比较在一个治疗周期内启动MDD治疗的影响， PCMH与传统初级保健环境对治疗质量和结局的影响，并评估其 有助于减少种族/民族差异。在Andersen/Aday医疗保健准入模型的指导下，我们 我将检验一个假设，即获得高结构质量的初级保健（行为服务整合 目前）可以有益于少数群体，并减少工艺质量方面的种族/民族差异 (MDD识别，治疗率和治疗质量），最终导致减少种族/民族差异， 结果质量（减少急诊室就诊和精神病医院入院）。这项创新研究是 第一个同时检查服务托管和远程精神病学及其相关性的质量影响 儿童精神障碍的种族/民族差异。调查结果将告知决策者的有效性， 目前正在实施的PCMH举措。

Project Summary: Racial/ethnic disparities in mental health care for youth remain large and persistent despite national attention to disparity reduction. Youth from minority racial/ethnic groups are approximately one-third to one-half as likely to receive mental health care as white youth. Disparities exist not only in initial access to care, but also in service completion and quality. These disparities in care access and quality likely contribute to the greater persistence, severity, and disease burden of mental disorder among African Americans and Latinos in adulthood. Due to the severe shortage of child and adolescent psychiatrists, primary care settings have become the first point of contact and the treatment site for all children and adolescents with behavioral issues. The patient centered medical home (PCMH) has been demonstrated as a promising model to empower primary care providers to perform screening, treatment and monitoring for pediatric mental disorders. However, its implication for addressing disparities has not yet been directly assessed. The Goal of the proposed research is to examine whether access to PCMH with integrated behavioral services, achieved through either service colocation or telepsychiatry, could remedy disparities in the care for pediatric major depressive disorders (MDD). In collaboration with one of the largest Medicaid managed care plan in southeast Texas, with more than 400,000 pediatric enrollees, we will combine the most recent Medicaid claims data (2013-16) with provider characteristics and systematic factors such as practice setting, practice size, and geographic location. Service colocation will be ascertained based on Geocoding, and the use of telepsychiatry will be identified using the Current Procedural Terminology codes. Our aims are: I. To examine the impact of having a PCMH as the “usual care provider” on the identification of MDD and to assess its association with the racial/ethnic disparity in MDD diagnosis rate; II. To compare the likelihood of receiving MDD treatment between those MDD cases first diagnosed at a PCMH versus traditional primary care, and to assess its association with the racial/ethnic disparity in MDD treated rate; III. To compare the impact of initiating MDD treatment within a PCMH versus a traditional primary care setting on the treatment quality and outcomes and to assess its contribution to racial/ethnic disparity reduction. Guided by the Andersen/Aday health care access model, we will test the Hypothesis that accessing primary care with high structural quality (behavioral service integration present) can disproportionally benefit the minority groups and reduce racial/ethnic disparity in process quality (MDD identification, treated rates, and treatment quality), eventually leading to reduced racial/ethnic disparity in outcome quality (fewer emergency room visits and psychiatric hospital admissions). This innovative study is the first that concurrently examines the quality impact of service colocation and telepsychiatry and its relevance to racial/ethnic disparities in pediatric mental disorders. Findings will inform policy makers the effectiveness of the PCMH initiatives currently being implemented.