1/2-Building Infrastructure for Community Capacity in Accelerating Integrated Care

1/2-为加速综合护理的社区能力建设基础设施

基本信息

批准号：
10333212
负责人：
MARGARITA ALEGRIA
金额：
$ 99.66万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-01 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10333212
关键词：
Address Adoption Affordable Care Act Automobile Driving Caring Case Manager Characteristics Chinese Client Clinic Communities Community Health Aides Development Elements Evidence based intervention Face Fee-for-Service Plans Goals Health Health Personnel Healthcare Home Human Resources Immigration Individual Infrastructure Insurance Carriers International Intervention Language Linguistics Link Low income Maintenance Massachusetts Measures Mediator of activation protein Medicaid Medicaid eligibility Mental Health Mental Health Services Minority Minority Groups Modeling North Carolina Outcome Participant Patient-Centered Care Patients Performance Personal Satisfaction Physicians Population Provider Quality of Care Research Resource-limited setting Resources Risk Behaviors Role Services Site Social Work System Testing Training Work anxiety symptoms barrier to care base bilingualism care coordination care delivery care systems collaborative care community based service community engagement community partnership community setting computerized contextual factors cultural competence depressive symptoms disparity reduction effectiveness testing eligible participant ethnic minority evidence base experience health care delivery health literacy implementation evaluation implementation outcomes implementation process improved improved functioning innovation intervention effect intervention program low and middle-income countries low income country member minority disparity multidisciplinary patient population physical conditioning population based population health primary care services provider networks racial and ethnic racial health disparity service providers social training opportunity

项目摘要

PROJECT SUMMARY Although individuals from racial/ethnic and linguistic minority groups make up a considerable—and growing— proportion of the US population, they experience greater unmet need for mental health care than non-Latino Whites. Members of these groups are heavily represented in Medicaid, the largest insurer covering the most vulnerable individuals. And although the Affordable Care Act expanded Medicaid eligibility, research to date has not found that expansions have decreased the gap in mental health treatment between Whites and racial/ethnic minorities. Experts have identified a lack of culturally competent, bilingual/bicultural mental health providers as a factor contributing to the maintenance of these disparities. Similar challenges have been addressed in lower-income countries facing severe workforce constraints through the training of community health workers (CHWs), who originate from the communities they serve and have shown promise internationally as mental health service providers. However, they have not yet typically served in this role in US care delivery systems. State Medicaid-based accountable care organizations (ACOs) are forming in large numbers to provide care coordination via team-based approaches, with accumulating evidence suggesting that this strategy can greatly benefit resource-poor populations. However, many ACOs have not yet incorporated mental health services into their networks, despite the observed link between addressing mental health needs and improving physical health. Building staff capacity to provide these needed services would help ACOs implement evidence-based mental health interventions and improve the overall well-being of their assigned patients. Thus, our proposed collaborative R01 will develop ACO-academic-community partnerships in two demographically different states at different stages of ACO development and test a model that trains CHWs to serve as mental health providers within clinics/physician's organization and community-based organizations linked to ACOs in North Carolina and Massachusetts. This effort should expand ACO infrastructures and increase access to and quality of mental health care for low-income racial/ethnic and linguistic minorities in resource-poor communities. If successful, we will work with our ACO site partners to assess implementation outcomes of adoption, fidelity, maintenance, and explore implementation processes (facilitators and contextual factors) as potential mediators of implementation within diverse clinics, CBOs, and ACO networks.

项目摘要尽管来自种族/种族和语言少数群体的个人构成了相当大的成长美国人口的比例，他们对精神卫生保健的需求比非latino更大白人。这些团体的成员在Medicaid中大量代表，Medicaid是最大的保险公司脆弱的人。尽管《负担得起的护理法》扩大了医疗补助资格，但迄今为止的研究尚未发现扩张减少了白人心理健康治疗的差距种族/族裔少数民族。专家已经确定缺乏文化胜任的双语/双文化心理健康提供者是促进这些差异的因素。类似的挑战也是如此通过培训社区，在低收入国家面临严重劳动力限制的问题卫生工作者（CHW）源自他们所服务的社区，并表现出承诺在国际上作为心理健康服务提供者。但是，他们通常尚未在我们中担任这个角色护理输送系统。基于州医疗补助的责任医疗机构（ACO）正在大规模形成通过基于团队的方法提供护理协调的数字，积累的证据表明该策略可以极大地使资源贫乏的人群受益。但是，许多ACO尚未合并心理健康服务进入其网络，DOS在满足心理健康需求之间观察到的联系并改善身体健康。建立员工提供这些所需服务的能力将有助于ACO 实施基于证据的心理健康干预措施并改善分配的整体福祉患者。这，我们提出的协作R01将在两个中建立aco-学术 - 社区合作伙伴关系在ACO开发的不同阶段，人口统计学不同的状态并测试了将CHW训练至的模型在诊所/医师组织和社区组织中充当心理健康提供者与北卡罗来纳州和马萨诸塞州的ACO相关。这项工作应扩大ACO基础架构和增加对低收入种族/种族和语言少数群体的精神卫生保健获得和质量资源贫民社区。如果成功，我们将与我们的ACO网站合作伙伴合作评估实施采用，忠诚，维护和探索实施过程的结果（促进者和上下文因素）作为潜水诊所，CBO和ACO网络中实施的潜在介体。