Improving Minority Health by Monitoring Medicaid Quality, Disparities and Value

通过监测医疗补助质量、差异和价值来改善少数群体的健康

基本信息

批准号：
10169888
负责人：
Marcela V Horvitz-Lennon
金额：
$ 19.72万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-20 至 2022-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10169888
关键词：
Address Adherence Administrative Supplement Adopted Adoption Adult Affect Antipsychotic Agents COVID-19 COVID-19 pandemic Caring Chronic Continuity of Patient Care Contracts Country Data Data Sources Development Diabetes Mellitus Disease Outbreaks Effectiveness Emergency Situation Ethnic Origin Funding Future General Practitioners Geographic state Guidelines Health Health Care Costs Healthcare High Prevalence Individual Interruption Latino Life Life Expectancy Measurement Measures Medicaid Medical Medical emergency Mental Health Mentally Ill Persons Minority Modeling Monitor Morbidity - disease rate New York Outcome Parents Patients Persons Play Policies Population Population Heterogeneity Positioning Attribute Premature Mortality Provider Psyche structure Psychiatric therapeutic procedure Race Readiness Research Research Personnel Role Schizophrenia Series Services State Interests Subgroup Time Visit Vulnerable Populations Work acute care beneficiary burden of illness care outcomes cost cost effectiveness design disability disadvantaged population effectiveness measure ethnic minority population evidence base experience health care availability health care cost/financing health care delivery health care disparity health disparity high risk population hospital readmission improved insight interest minority health mortality pandemic disease physical conditioning programs psychiatric emergency public health relevance racial and ethnic racial and ethnic disparities response severe mental illness social disadvantage study population telehealth tool

项目摘要

PROJECT SUMMARY Schizophrenia is a serious mental illness associated with a high burden of disease due to severe disability and premature mortality largely driven by co-occurring chronic medical conditions that shorten life expectancy by at least 20 years. The broad array of services needed by this population are primarily financed by Medicaid. Despite high costs, most patients do not receive recommended care, and minorities are less likely to do so than whites. These pre-existing disparities and the profound social disadvantage also experienced by this population make them particularly vulnerable to the devastation caused by the COVID-19 pandemic, which in the US has been particularly severe in the state of New York. New Yorkers with schizophrenia, and minorities in particular, are not only a high-risk group for poorer COVID-19 outcomes but they may also experience declines in their health due to disruptions in their ability to access healthcare. Although New York’s Medicaid program authorized the use of telehealth to mitigate those disruptions soon after the Governor declared a State of Emergency in early March 2020, the degree to which telehealth has been adopted by Medicaid providers serving seriously mentally ill people and whether the effects of telehealth adoption may vary by race/ethnicity are not well known. Our proposed administrative supplement application builds on our ongoing NIMHD-funded parent study (MD012428), which seeks to reduce healthcare disparities and thus improve health outcomes of racial/ethnic minority populations through measurement of quality disparities and value (or cost-effectiveness) of Medicaid-financed care delivered to adults with schizophrenia. Consistent with the NIMHD’s Notice of Special Interest calling for studies of the impact of the COVID-19 outbreak on health disparity populations, we propose to evaluate the effects of the outbreak on the racially/ethnically diverse population of Medicaid beneficiaries with schizophrenia living in New York. In Aim 1, we will assess the effect of the outbreak on racial/ethnic disparities in access, quality, and effectiveness of mental and physical healthcare delivered to our study population. In Aim 2, we will assess Medicaid providers’ responses to the outbreak and their effects on healthcare disparities in our study population. We will characterize provider response through a measure of provider readiness to adopt telehealth. Our general approach to assessing the impact of the outbreak on healthcare outcomes and the impact of provider responses on those outcomes will involve the use of post-pre outbreak differences, interrupted time series approaches, as well as approaches that utilize time-varying coefficients. In all analyses, our primary interest are parameters that describe how race/ethnicity moderates the outbreak’s effect on outcomes and the providers’ responses on outcomes. We expect that our work will provide policymakers with a better understanding of the impacts of the outbreak on vulnerable populations and enable the design of more effective policies to address this and future crises.

项目概要精神分裂症是一种严重的精神疾病，由于严重残疾和疾病负担而导致高负担。过早死亡主要是由同时发生的慢性疾病造成的，这些疾病会缩短预期寿命至少 20 年，该人群所需的广泛服务主要由医疗补助提供资金。尽管费用很高，但大多数患者没有接受推荐的护理，少数人则不太可能这样做这些预先存在的差异和深刻的社会劣势也由此而经历。人口使他们特别容易受到 COVID-19 大流行造成的破坏，美国纽约州的精神分裂症患者和少数族裔的情况尤其严重。特别是，他们不仅是 COVID-19 结果较差的高风险群体，而且还可能经历尽管纽约的医疗补助计划受到影响，但他们的健康状况却下降了。在州长宣布州成立后不久，该计划就授权使用远程医疗来减轻这些干扰 2020 年 3 月上旬的紧急情况，医疗补助提供商采用远程医疗的程度为患有严重精神疾病的人提供服务，以及采用远程医疗的效果是否会因种族/民族而异我们提出的行政补充申请是建立在我们正在进行的 NIMHD 资助的基础上的。家长研究 (MD012428)，旨在减少医疗保健差异，从而改善健康结果通过衡量质量差异和价值（或成本效益）来衡量种族/族裔少数群体向成年精神分裂症患者提供的医疗补助资助的护理与 NIMHD 的通知一致。特别关注呼吁研究 COVID-19 爆发对人群健康差异的影响，我们提议评估疫情爆发对医疗补助的种族/民族多样化人群的影响在目标 1 中，我们将评估疫情对居住在纽约的精神分裂症受益人的影响。向我们提供的精神和身体保健服务的获取、质量和有效性方面存在种族/民族差异在目标 2 中，我们将评估医疗补助提供者对疫情的反应及其对人群的影响。我们将通过衡量提供者的反应来描述我们研究人群的医疗保健差异。提供商准备采用远程医疗我们评估疫情爆发影响的一般方法。医疗保健结果以及提供者的反应对这些结果的影响将涉及使用后预爆发差异、中断时间序列方法以及利用时变的方法在所有分析中，我们的主要兴趣是描述种族/民族如何调节的参数。我们期望我们的工作能够提供疫情对结果的影响以及提供者对结果的反应。决策者更好地了解疫情对弱势群体的影响，并能够设计更有效的政策来应对当前和未来的危机。

项目成果

期刊论文数量（1）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Healthcare Access for a Diverse Population with Schizophrenia Following the Onset of the COVID-19 Pandemic.

COVID-19 大流行爆发后，为不同的精神分裂症患者提供医疗服务。

DOI：
发表时间：
2024-01
期刊：
影响因子：
2.7
作者：
Horvitz;Leckman;Finnerty, Molly;Jeong, Junghye;Tsuei, Jeannette;Zelevinsky, Katya;Chen, Qingxian;Normand, Sharon
通讯作者：
Normand, Sharon