Reducing Health Disparities in SMI, Rural and Minority Populations

 描述(由申请人提供)：65岁以下有资格享受医疗保险(MD&lt；65)的残疾人在获得医疗保健方面似乎面临着独特的挑战，健康状况不佳，护理费用高昂，尽管对人口的研究仍然有限。并存的严重精神疾病似乎加强了残疾和不良健康结果之间的联系。这项研究通过检查自我照顾能力、其与健康状况的关系，以及在14年期间对选定的疾病轨迹和健康结果的影响，考虑到社区支持健康的能力、医疗保健的质量以及性别、种族和乡村的交叉影响，来解决MD&lt；65的残疾和共病精神疾病的影响。将比较三组MD&lt；65人的医疗保健经历：肢体残障(PHY)、肢体残障合并精神障碍(CMD)和严重精神病残障(SMI)，然后与65岁及以上的联邦医疗保险接受者进行对比。这项研究的设计和分析是由两个PI开发的经验性支持的多因素健康结果模型指导的。调查人员将使用联邦医疗保险当前受益人调查(MCBS)和联邦医疗保险索赔数据(MCD)，采用多水平分析，首先检查社区能力对47,680名医疗保险接受者(MD&lt；65)的自我护理能力和健康状况的影响，并与MD&>；65的PHY、CMB和SMI进行对比。下一步，将为患有心血管疾病(CVD)和糖尿病(DM)的人构建详细的14年纵向医疗保健概况，这两种疾病在残疾人中普遍存在。采用纵向总体分析设计，研究人员将估计生存 关于选定结果的健康/疾病轨迹，包括每组的死亡率。在每个分析水平上，调查人员还将检查性别、种族和农村的影响，以评估每种身份的交叉影响进一步影响发病率和死亡率差异的程度。将联邦医疗保险索赔数据与我们将在拟议研究中使用的其他数据集聚合在一起，将使我们能够识别导致健康状况恶化、利用率增加和医疗成本高昂的社区和医疗系统因素，这反过来将使调查人员能够对个人和系统级别的医疗干预措施提出具体建议。这项拟议的研究将提供关于MD&lt；65作为一个整体的关键信息，以及健康和精神健康并存如何在每个群体中产生和影响健康结果差异的发展。

 DESCRIPTION (provided by applicant): Disabled persons under the age of 65 who qualify for Medicare (MD<65) appear to have unique challenges in obtaining health care, poor health outcomes, and high costs of care although research on the population remains limited. Comorbid and serious mental illness appears to strengthen the association between disability and poor health outcomes. This study addresses the effects of disability and comorbid mental illness of the MD<65 by examining self-care capacity, its relationship to health status, and over a 14-year period, to selected illness trajectories and health outcomes, considering community capacity to support health, quality of health care, and intersecting effects of gender, race, and rurality. The health care experiences of three groups of the MD<65 will be compared: the physically disabled (PHYS), physically disabled with co-morbid mental disorders (CMD), and seriously mentally ill disabled (SMI) and then contrasted with Medicare recipients 65 and older. The study design and analyses are guided by an empirically supported multi-factorial health outcomes model developed by the two PIs. Investigators will use the Medicare Current Beneficiary Survey (MCBS) and Medicare Claims data (MCD) employing multilevel analyses, will first examine the influence of community capacity on self-care capacity and health status for 47,680 Medicare recipients, MD<65 with PHYS, CMB, and SMI contrasted with MD>65. Next, detailed 14-year longitudinal profiles of received health care will be constructed for those with cardiovascular disease (CVD) and diabetes mellitus (DM), co-morbidities prevalent in the disabled. Employing a longitudinal, population analytic design investigators will estimate survival on health/illness trajectories for selected outcomes including mortality in each group. At each level of analysis investigators will also examine the influence of gender, race, and rurality to assess the extent to which intersecting effects of each identity further affect morbidity and mortality disparities seen. The aggregation of Medicare claims data with other datasets we will use in the proposed research will enable us to identify community level and health system factors that contribute to worsening health, increased utilization, and high health care costs which, in turn will enable investigators to make specific recommendations for individual and system level health care interventions. The proposed research will provide key information about MD<65 as a whole and how health and mental health comorbidities accrue and influence the development of disparities in health outcomes in each group.