Estimating person parameters via item response model and simple sum score in small samples with few polytomous items: A simulation study

Racial-Ethnic Disparities in Quality of Care Among Medicaid Beneficiaries With Schizophrenia

OBJECTIVE

The authors sought to update and expand the evidence on the quality of health care and disparities in care among Medicaid beneficiaries with schizophrenia.

METHODS

Adult beneficiaries of New York State Medicaid with schizophrenia receiving care during 2016-2019 were identified. Composite quality scores were derived from item response theory models by using evidence-based indicators of the quality of mental and general medical health care. Risk-adjusted racial-ethnic differences in quality were estimated and summarized as percentiles relative to White beneficiaries' mean quality scores.

RESULTS

The study included 71,013 beneficiaries; 42.8% were Black, 22.9% Latinx, 27.4% White, and 6.9% other race-ethnicity. Overall, 68.8% had a mental health follow-up within 30 days of discharge, and 90.2% had no preventable hospitalizations for chronic obstructive pulmonary disease or asthma. Among beneficiaries receiving antipsychotic medications, medication adherence was adequate for 43.7%. Fourteen indicators for mental and general medical health care quality yielded three composites: two for mental health care (pharmacological and ambulatory) and one for acute mental and general medical health care. Mean quality of pharmacological mental health care for Black and Latinx beneficiaries was lower than for White beneficiaries (39th and 44th percentile, respectively). For Black beneficiaries, mean quality of ambulatory mental health care was also lower (46th percentile). In New York City, Black beneficiaries received lower-quality care in all domains. The only meaningful group difference in the quality of acute mental and general medical health care indicated higher-quality care for individuals with other race-ethnicity.

CONCLUSIONS

Disparities in the quality of Medicaid-financed health care persist, particularly for Black beneficiaries. Regional differences merit further attention.

Low-Carbon Travel Motivation and Constraint: Scales Development and Validation

Low-carbon travel has emerged as a topic of interest in tourism and academia. Studies have offered reasons tourists may engage in low-carbon travel; however, these explanations are scattered throughout the literature and have yet to be integrated into low-carbon travel motivation and constraint constructs. This study develops a low-carbon travel motivation scale (LCTMS) and a low-carbon travel constraint scale (LCTCS). It performs reliability and validity testing to measure the low-carbon travel motives and obstacles. Items were collected primarily by literature review, and, then, by surveys of 382 tourists from low-carbon travel destinations and 390 from non-low-carbon travel destinations. Through a rigorous scale development process, this study identifies six dimensions of the LCTMS (environmental protection, experience-seeking, escape or social connection, industry pleas and measures for environmental protection, low-carbon products, and green transportation) and four dimensions of the LCTCS (intrapersonal constraints, interpersonal constraints, structural constraints, and the not a travel option).