INTEGRATING PHYSICAL AND MENTAL CARE FOR ADULTS WITH SERIOUS MENTAL ILLNESS

为患有严重精神疾病的成年人提供身心综合护理

基本信息

批准号：
9071668
负责人：
JOSHUA A BRESLAU
金额：
$ 11.77万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-05 至 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9071668
关键词：
Accident and Emergency department Accounting Adult Award Bipolar Disorder Budgets Cardiovascular Diseases Caring Clinic Clinical Code Contracts Data Diabetes Mellitus Economics Evaluation Expenditure Funding General Population Grant Growth HIV Health Health Care Costs Health Services Health Services Research Health Status Health system Healthcare Hepatitis Hypertension Incentive Reimbursement Individual Investments Life Expectancy Literature Medicaid Medical Mental Depression Mental Health Mental disorders Modeling Monitor New York Obesity Participant Patients Policies Primary Health Care Program Effectiveness Provider Psyche structure Public Health Public Sector Regulation Research Research Personnel Resources Schizophrenia Science Services Severities System Testing Time United States Substance Abuse and Mental Health Services Administration Universities Variant behavioral health cost design experience financial incentive health care delivery health care quality health care service utilization health disparity improved innovation inpatient service medical specialties mental health center mortality novel parity physical conditioning primary care setting programs research study screening severe mental illness simulation

项目摘要

DESCRIPTION (provided by applicant): The physical health status of people with severe mental illness (SMI) is a public health crisis. Individuals with SMI (e.g. schizophrenia, bipolar disorder, or severe depression) are more likely than the general population to suffer from physical health conditions, including hypertension, diabetes, obesity, cardiovascular disease, HIV, and hepatitis. SMI is associated with a reduction of about 9 years in life expectancy, about half of which is attributable to physical health conditions. Poor access to and low quality of health care contributes to these disparities. A leading proposal for improving the health of people with SMI is to integrate primary care services into specialty mental health clinics which already serve as their primary gateway into the medical system. However, the viability of this strategy to achieve sustained system-wide improvements in care for people with SMI has yet to be examined. This project takes advantage of two innovative integrated care programs and a unique data resource in New York State to assess the potential impact of integrating primary care services into specialty behavioral health clinics for people with SMI. The first integrated care program in New York was established through a Substance Abuse and Mental Health Services Administration (SAMHSA) demonstration project, the Primary Behavioral Health Care Integration (PBHCI) grant program. The RAND Corporation was awarded a contract from SAMHSA and the Assistant Secretary for Planning and Evaluation (ASPE) to evaluate the effectiveness of this program. The second integrated care program was initiated by the New York Office of Mental Health using a Medicaid reimbursement incentive to promote primary care services in specialty behavioral health clinics. The OMH program, which is on a much larger scale than the SAMHSA grant program, has yet to be examined empirically with respect to its impact on health care. For this project, the RAND research team has joined with a research team at NYU with extensive experience with quality of mental health care research in New York's Office of Mental Health. Together we will examine the financial viability of integrated care from the clinics' perspective, the impact of integrated care on health care utilization, quality, ad cost from a health system perspective and the long term budget impact of integrated care from the payer perspective. Data for this evaluation come from a unique resource of Medicaid claims data. If this model is successful, then expanding its availability could have a dramatic impact on the physical health status of people with SMI, helping to reduce one of the starkest of contemporary disparities in health. Determining the viability of this model is urgent because of the anticipated growth of public sector mental health care and in state-level programs designed to incentivize integrated care for people with SMI.

描述（由申请人提供）：严重精神疾病（SMI）的身体健康状况是公共卫生危机。患有SMI（例如精神分裂症，躁郁症或严重抑郁症）的人比普通人群更有可能患有身体健康状况，包括高血压，糖尿病，肥胖，心血管疾病，HIV和肝炎。 SMI与预期寿命减少了约9年有关，其中大约一半归因于身体健康状况。医疗保健质量和低质量的差异会导致这些差异。改善SMI健康状况的领先建议是将初级保健服务纳入专业的心理健康诊所，这些诊所已经是通往医疗系统的主要门户。但是，尚未研究这种策略以实现SMI患者的持续全系统护理改进的策略的可行性。该项目利用了纽约州的两个创新的综合护理计划和一个独特的数据资源来评估将初级保健服务纳入SMI患者的专业行为健康诊所的潜在影响。纽约的第一个综合护理计划是通过滥用药物和精神卫生服务管理局（SAMHSA）示范项目（主要行为卫生保健整合（PBHCI）赠款计划）建立的。兰德公司（Rand Corporation）获得了SAMHSA的合同和计划和评估助理秘书（ASPE），以评估该计划的有效性。第二个综合护理计划是由纽约心理健康办公室发起的，使用医疗补助报销激励措施在专业行为健康诊所中促进初级保健服务。 OMH计划的规模比SAMHSA赠款计划大得多，但尚未就其对医疗保健的影响进行经验研究。对于这个项目，RAND研究团队与纽约大学的一个研究团队一起，在纽约心理健康办公室的精神保健研究质量方面拥有丰富的经验。我们将共同研究综合护理的财务可行性从诊所的角度来看，从卫生系统的角度来看，综合护理对医疗保健利用，质量，广告成本的影响以及从付款人的角度来看，综合护理的长期预算影响。此评估的数据来自医疗补助索赔数据的独特资源。如果该模型成功，那么扩大其可用性可能会对SMI患者的身体健康状况产生巨大影响，从而减少当代健康差异最严重的人之一。由于公共部门心理保健的预期增长以及旨在激励SMI患者综合护理的州级计划，确定该模型的可行性是紧迫的。