title: Racial and ethnic service use disparities among homeless adults with severe mental illnesses receiving ACT.
abstract: OBJECTIVE
  Case management-based interventions aimed at improving quality of care have the potential to narrow racial and ethnic disparities among people with chronic illnesses. The aim of this study was to assess the equity effects of assertive community treatment (ACT), an evidence-based case management intervention, among homeless adults with severe mental illness.
  
  
  METHODS
  This study used baseline, three-, and 12-month data for 6,829 black, Latino, and white adults who received ACT services through the ACCESS study (Access to Community Care and Effective Services and Support). Zero-inflated Poisson random regression models were used to estimate the adjusted probability of use of outpatient psychiatric services and, among service users, the intensity of use. Odds ratios and rate ratios (RRs) were computed to assess disparities at baseline and over time.
  
  
  RESULTS
  No disparities were found in probability of use at baseline or over time. Compared with white users, baseline intensity of use was lower for black users (RR=.89; 95% confidence interval [CI]=.83-.96) and Latino users (RR=.65; CI=.52-.81]). Intensity did not change over time for whites, but it did for black and Latino users. Intensity increased for blacks between baseline and three months (RR=1.11, CI=1.06-1.17]) and baseline and 12 months (RR=1.17, CI=1.11-1.22]). Intensity of use dropped for Latinos between baseline and three months (RR=.83, CI=.70-.98).
  
  
  CONCLUSIONS
  Receipt of ACT was associated with a reduction in service use disparities for blacks but not for Latinos. Findings suggest that ACT's equity effects differ depending on race-ethnicity.
authors.affiliation: RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA. mhorvitz@rand.org
authors.forename: Marcela
authors.initials: M
authors.lastname: Horvitz-Lennon
authors.forename: Dongli
authors.initials: D
authors.lastname: Zhou
authors.forename: Sharon-Lise T
authors.initials: SL
authors.lastname: Normand
authors.forename: Margarita
authors.initials: M
authors.lastname: Alegría
authors.forename: Wes K
authors.initials: WK
authors.lastname: Thompson
mesh_terms: D000328:Adult; D044383:Black People / Q000523:psychology* / Q000706:statistics & numerical data*; D019090:Case Management / Q000706:statistics & numerical data; D002908:Chronic Disease; D015331:Cohort Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data*; D006630:Hispanic or Latino / Q000523:psychology* / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D010414:Pennsylvania; D011336:Probability; D011618:Psychotic Disorders / Q000208:ethnology* / Q000628:therapy*; D014600:Utilization Review / Q000706:statistics & numerical data; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data*; D001741:Black or African American