Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

• Identify disparities and reasons for disparities and reevaluate the framework for researching disparities The following article was used in answering this question: Davis, L. M., Kilburn, M. R., and Schultz, D. (2009). Reparable Harm: Assessing and Addressing Disparities Faced by Boys and Men of Color in California. RAND Monographs.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

“Strategies to personalize/individualize treatment” priority

• Compare the effectiveness of psychotropic medications in subgroups of patients (e.g., age, race, and common comorbidities) to identify variation in patient responses and predictors of response that could inform the selection of treatments.
• Compare the effectiveness of various strategies to best individualize pharmacologic therapy for people with SMI, including how to most efficiently find a tolerable regimen.

“Interventions for people with comorbid medical illness or substance abuse” priority

• Compare the effectiveness of pharmacologic and nonpharmacologic interventions for people with SMI and comorbid medical illnesses (e.g., diabetes, HIV, and cardiovascular disease).

“Reducing barriers and improving access” priority

• Compare the effectiveness of sustainable interventions to reduce barriers to access for mental health services, including transportation, financial barriers, and insurance coverage barriers. For example, for those with clearly documented SMI, intervention groups (vs. bureaucracy?as?usual groups) could have streamlined access to Medicaid including access to essential medication while benefits are pending, meeting with a Medicaid worker at their home or their follow-up care site rather than at social services, automatic Medicaid renewal rather than having to re?register, ability to re?enter the work force part?time without losing key benefits, etc. What about changes in benefits packages to enhance health promotion (e.g., giving additional money for food stamps but designating a certain percent that can only be used for fresh fruits and vegetables (One nominator suggested deleting this item.)
• Compare the effectiveness of strategies to obtain regular dental care for people with SMI on outcomes such as quality of life and physical well-being.
• Compare the effectiveness of strategies to reduce the barriers to accessing effective programs and to sustaining recovery for un

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Patients with Serious Mental Illness (SMI).

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

• This question specifically addresses subgroups where disparities in diagnosis, treatment, access to care, etc., may exist, and would include subgroups based on such factors as age, race/ethnicity, gender, language, geographic location (rural/urban) as well as other sociodemographic factors such as education, income, etc.
• Boys and men of color See Davis, L. M., Kilburn, M. R., and Schultz, D. (2009). Reparable Harm: Assessing and Addressing Disparities Faced by Boys and Men of Color in California. RAND Monographs.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

• Determining who or what is successful in addressing disparities for SMI has the potential to improve outcomes, quality of life, patient satisfactions/happiness, and customer services.
• Understanding reasons for disparities will reduce barriers and increase access to care for underserved populations.

Describe any health-related risks, side effects, or harms that you are concerned about.

• Some subgroups of interest may include vulnerable populations (e.g., elderly, non-English speaking individuals) with whom greater care must be taken in research endeavors.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Depression and other mental health disorders
• Obesity

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Various reasons for disparity need to be addressed and include: 1) Barriers and access issues, 2) Clinical, 3) Systems, and 4) Institutional racism.

• We must reevaluate the framework for subpopulation research—identify why current research isn’t answering the questions. To break through the current status quo on resolving disparities, perhaps we need to experiment with a different funding mechanism, asking communities to initiate research studies and having community representative act as research review panels.
• Mental Health Research seems far behind and needs a major overhaul. Specifically, there is a need for more research focus on specific racial and ethnic communities and any research focus should include outcomes specific to these populations. Such research must address the overall lack of evidence-based practice inclusion of racial and ethnic communities as participants in research.
• Data needs to be cleaned up. Researchers must define Latino population more clearly (Mexican, Puerto Rican, South American) and include data such as: 1) Years in the USA, 2) Language data, and 3) acculturation data. The disaggregating of data for subpopulations to identify disparities is also important.
• There is a need to document disparity in public and private settings, look at the causes and risk factors for lack of services to people with limited English-language skills, and understand how to get data from the patient perspective (e.g., what are the outcomes of interest from the specific disparities?).
• What are the disparities within communities? We need to identify community-defined evidence, determine how to support community infrastructure, and find research collaboratives in community based organizations. Questions to address include “What is working in communities with regard to how to get better outcomes?” and “What are best practices in the community?”
• We need to determine how to develop workforce diversity.
• How do we get grassroots organizations to

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

• The need for strategies to identify disparities and reasons for disparities, and reevaluate the framework for researching disparities, was identified as one of the top priority topics by stakeholders attending the AHRQ Issues Exploration Forum (IEF) on Serious Mental Illness, July-August, 2010.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Please see Davis, L. M., Kilburn, M. R., and Schultz, D. (2009). Reparable Harm: Assessing and Addressing Disparities Faced by Boys and Men of Color in California. RAND Monographs.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

• By promoting a greater awareness to the plight of boys and men of color.

Describe the timeframe in which an answer to your question is needed.

As soon as possible. This topic was prioritized during a series of stakeholder meetings focused on SMI, held July-August 2010.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

• Racial profiling of boys and men of color has indicated a lower quality of mental health services provided.

See Davis, L. M., Kilburn, M. R., and Schultz, D. (2009). Reparable Harm: Assessing and Addressing Disparities Faced by Boys and Men of Color in California. RAND Monographs.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

• By promoting a greater awareness to the plight of boys and men of color.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

We were asked to participate by the Oregon Health and Science University on behalf of the Agency for Healthcare Research and Quality’s (AHRQ) Effective Health Care (EHC) Program