Comparative Effectiveness Research Diffusion and Mental Health Care Disparities

比较有效性研究扩散和心理保健差异

• 批准号: 8882222
• 负责人: Benjamin Le Cook
• 金额: $ 24.92万
• 依托单位: CAMBRIDGE HEALTH ALLIANCE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-10 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8882222
• 关键词: Comparative; Effectiveness; Research; Diffusion; Mental

DESCRIPTION (provided by applicant): Comparative Effectiveness Research (CER) compares benefits and risks of different treatments. However, little is known about the impact of large-scale CER implementation as conceived in the 2010 Affordable Care Act (ACA) on equity in health care across racial/ethnic groups. Identifying the influence of FDA risk warnings on disparities in psychotropic drug use provides a platform to understand how CER will influence disparities in certain situations. Disparity methods have typically not taken into account specific recommendations and warnings on effectiveness and safety. With the advent of the ACA and continued concern over persistent disparities, it is imperative that disparities research continues to evolve to incorporate lessons learned from CER. We capitalize upon time trends in warnings and advisories to understand disparities in diffusion with the intention of identifying policies tht might avert the negative equity consequences of incorporating CER into routine practice. Specifically, we 1) Track changes in antidepressant use among youth and antipsychotic drug use among youth and adults by racial/ethnic group as they are influenced by CER-generated risk warnings and advisories; 2) Assess whether specific information in FDA warnings influenced disparity trends in a) treatments recommended by CER-generated evidence (e.g., fluoxetine use and metabolic screening for antipsychotic users); and b) psychotropic drug use that is potentially harmful (e.g., olanzapine use); and 3) Identify how provider characteristics an HMO enrollment act as mechanisms that underlie the differential diffusion of CER via health risk warnings. We implement the Institute of Medicine (IOM) definition of healthcare disparities in order to capture trends in disparities over time, overlaying timelines of warnings and recommendations related to antidepressant and antipsychotic drugs. We adapt IOM methods by decomposing disparities in overall drug use into disparities in specific categories of use mentioned by FDA warnings as carrying particular risk or benefit. If we find racial/ethnic disparities in diffusion of risk warnings and advisories, this suggests policymakers should focus on improving uptake of CER among minorities. If we identify that certain providers and HMO membership influences disparities in diffusion, this will lead to recommendations for policymakers of actionable policies to avert the negative equity consequences of incorporating CER into routine practice.

描述（由申请人提供）：比较有效性研究（CER）比较了不同治疗方法的益处和风险。但是，关于2010年《平价医疗法案》（ACA）对种族/族裔跨种族卫生保健公平的大规模CER实施的影响知之甚少。确定FDA风险警告对精神药物使用差异的影响提供了一个平台，以了解CER如何影响某些情况下的差异。差异方法通常不考虑特定的 有关有效性和安全性的建议和警告。随着ACA的出现，并继续关注持续的差异，必须继续进行差异。 进化以纳入从CER中学到的经验教训。 我们利用警告和咨询的时间趋势来理解扩散的差异，目的是确定政策可能避免将CER纳入常规实践的负值后果。具体而言，我们1）追踪年轻人在年轻人和成年人中受到种族/族裔群体在青年和成人中使用抗抑郁药的变化，因为它们受到CER生成的风险警告和咨询的影响； 2）评估FDA警告中的特定信息是否影响了A）Cer生成的证据建议的治疗方法（例如，使用氟西汀的使用和抗精神病药使用者的代谢筛查）； b）潜在有害的精神药物使用（例如，使用奥氮平）； 3）确定提供者如何特征HMO入学行为是通过健康风险警告差异扩散的机制。 我们实施医学研究所（IOM）对医疗保健差异的定义，以捕获随着时间的推移差异的趋势，覆盖了与抗抑郁药和抗精神病药有关的警告和建议的时间表。我们通过将整体药物使用的差异分解为FDA警告中提到的特定使用类别的差异来调整IOM方法，以携带特定的风险或受益。如果我们发现风险警告和咨询的传播中种族/种族差异，这表明决策者应专注于改善少数民族的CER吸收。如果我们确定某些提供者和HMO成员资格会影响扩散的差异，这将为可行的政策制定者提出建议，以避免将CER纳入常规实践的负值后果。