Understanding Disparities in Preventive Services for Patients with Mental Illness

了解精神疾病患者预防服务的差异

• 批准号: 8895407
• 负责人: BobbiJo H. Yarborough
• 金额: $ 69.74万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8895407
• 关键词: Address; Adult; Adverse effects; Affect; Age; Bipolar Disorder; Caring; Characteristics; Chronic; Chronic Disease; Clinic; Community Mental Health Centers; Community Networks; Computerized Medical Record; County; Data; Development; Diagnosis; Disease; Excess Mortality; Federally Qualified Health Center; Goals; Guidelines; Health Planning; Health system; Home environment; Individual; Intervention; Interview; Life; Life Expectancy; Major Depressive Disorder; Measures; Medical; Mental Health Services; Mental disorders; Metabolic; Methods; Morbidity - disease rate; Patients; Pattern; Perception; Pharmaceutical Preparations; Population; Prevention; Preventive; Primary Health Care; Provider; Psychiatric therapeutic procedure; Quality of life; Research; Research Design; Risk; Role; Schizophrenia; Series; Services; Structure; Surveys; System; Terminology; Testing; Underserved Population; Vulnerable Populations; aged; base; care systems; experience; health disparity; improved; mortality; patient home care; safety net; severe mental illness; uptake; willingness

DESCRIPTION (provided by applicant): The life expectancy of people with serious mental illness (SMI)-schizophrenia spectrum disorders, bipolar disorders-is about 25 years shorter than that those without SMI. This early mortality is due largely to preventable chronic conditions, including those caused or worsened by the metabolic side effects of medications prescribed for SMI. In addition to being at increased risk for life-threatening chronic conditions, patients with SMI may be less likely than those without SMI to receive the guideline-concordant preventive care for these disorders. Little is known, however, about overall patterns of preventive care service use among patients with SMI, or about modifiable factors at the patient, clinician, organizational, or regulatory level that affect uptake of preventive services. New initiatives to address health disparities experienced by individuals with SMI have been proposed, including creating medical care homes within psychiatric clinics and integrating medical and psychiatric care; yet it is unclear if such strategies represent the best approaches, given the dearth of research assessing the underlying factors that produce these disparities. We propose a 5-year, mixed methods study to examine the role of modifiable regulatory-, organizational-, provider-, provider-patient-, and patient-level factors contributing to disparities in preventive service use among patients with serious mental illness. We use electronic medical record data from a large non-profit integrated health plan and an equally large network of safety-net clinics to examine the preventive service use of approximately 65,000 individuals with SMI (age 18 and over), and compare them to similarly aged individuals without SMI (n > 700,000) to identify patient, provider, organizational, and regulatory predictors of preventive service use. We will also conduct a small number of formative, semi-structured interviews with patients and providers to develop a clinician survey and patient interview materials (structured and semi- structured). Information from clinician surveys will be used to predict preventive service use at the panel level. Semi-structured interviews with patients will be used to identify factors affecting willingness to seek preventive services and barriers to, and facilitators of, such service seeking. This mixed methods study will employ triangulated, complementary, methods to gain a nuanced understanding of factors responsible for disparate and inadequate preventive service use among SMI patients, and to identify possible methods for ameliorating barriers to service use. This information will inform ongoing efforts to improve delivery of medical care to individuals with SMI as well as initiatives targeting excess mortality in this population.

描述（由申请人提供）：患有严重精神疾病的人的预期寿命（SMI） - 疾病频谱疾病，双相情感障碍 - 比没有SMI的人短25年。这种早期死亡率很大程度上是由于可预防的慢性疾病，包括因SMI处方的药物的代谢副作用而导致或恶化的慢性疾病。除了危及生命的慢性病风险增加外，SMI患者可能比没有SMI接受这些疾病的指导方案预防性护理的可能性较小。然而，关于影响预防服务吸收的患者，临床医生，组织或监管水平的患者，或者在患者，临床医生，组织或监管水平上使用预防性护理服务的总体模式，几乎知之甚少。已经提出了解决SMI患者经历的健康差异的新举措，包括在精神病诊所内创建医疗院以及整合医学和精神病医疗；然而，鉴于评估产生这些差异的基本因素的研究的匮乏，尚不清楚这些策略是否代表了最佳方法。我们提出了一项为期5年的混合方法研究，以研究可修改的调节性，组织，提供者，提供者，患者和患者水平的因素的作用，这些因素导致严重精神疾病患者预防性服务的差异。我们使用来自大型非营利性综合健康计划和同样大的安全网络诊所网络的电子病历数据来检查大约65,000名SMI（18岁及以上）的人的预防服务使用，并将其与没有SMI的类似老年人（n> 700,000）进行比较，以识别患者，提供者，提供者，组织，组织，组织和预防性的预测者。我们还将与患者和提供者进行少量的形成性半结构化访谈，以开发临床医生调查和患者访谈材料（结构化和半结构化）。临床医生调查的信息将用于预测面板级别的预防服务。与患者的半结构化访谈将用于确定影响意愿寻求预防服务和障碍和促进者的因素。 这项混合方法研究将采用三角，互补的方法来获得对导致SMI患者不同预防性服务不足的因素的细微理解，并确定可以改善服务使用障碍的可能方法。这些信息将为正在进行的努力提供改善SMI个人提供医疗服务的努力，以及针对该人群过剩死亡率的倡议。