Advancing Patient Safety for Antipsychotic-Treated Children: Examining State Implementation of Safe Use Practices

提高接受抗精神病药物治疗的儿童的患者安全：检查国家安全使用实践的实施情况

• 批准号: 10456732
• 负责人: Stephen Crystal
• 金额: $ 37.36万
• 依托单位: RUTGERS, THE STATE UNIV OF N.J.
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-30 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456732
• 关键词: Advancing; Patient; Safety; Antipsychotic; Treated; Advancing; Patient; Safety; Antipsychotic; Treated

This project will address, at scale, improvement of safe use practices for antipsychotic (AP) treatment of Medicaid children. Safe and judicious management of APs poses significant challenges, given hazards that include elevated risk of Type 2 diabetes, weight gain, hyperglycemia, hyperlipidemia, and potential long-term impact on brain development. Safety evidence and guidelines highlight the importance of several key safe-use practices that can help mitigate these risks, including monitoring blood glucose and lipids; avoiding concurrent use of multiple different APs; first-line use of non-pharmacological mental health services; and minimizing use among pre-school children. Prior AHRQ-supported projects have led to HEDIS/CMS quality metrics for these practices, but their implementation is highly inconsistent. Many state initiatives have been implemented to improve these safe-use practices, but the impact of alternative strategies for increasing safe-use is unknown. Evidence on their effects is critically needed. We will use a mixed-methods strategy to identify and document state implementation of safe-use initiatives; assess their impact on safe use metrics; investigate causal mechanisms underlying effectiveness; and actively disseminate results to state decisionmakers, health plans, clinical communities, and other stakeholders. This process will support translation, implementation, and improvement of effective strategies across states. We will provide a comprehensive analysis of systems-level strategies, using a national survey and case studies in 8 purposively sampled states, to investigate distinctive approaches. We will use key informant interviews and systematic document review to identify implementation timelines, strategies, causal mechanisms, barriers and solutions, and tools utilized. We will then use Medicaid claims data to assess change in the use of the targeted practices following the implementation of state systems-level strategies, using difference-in-difference, triple-difference and other modeling strategies. States that did not implement similar initiatives will serve as comparators. Finally, we will actively disseminate an evidence-informed toolkit to state and stakeholder communities, utilizing active dissemination strategies successfully employed in prior AHRQ-supported partnerships. This toolkit will be developed to facilitate a self- assessment and prioritization of improvement initiatives, identification of other state strategies, and provide quality improvement and evaluation tools to assess effectiveness over time. Evidence development and active dissemination will assure that evidence on effective system-improvement processes is available, understood, and effectively used to improve patient safety across populations of vulnerable children served by state Medicaid/CHIP systems and reduce AP-related harms.

该项目将按大规模解决抗精神病药（AP）处理的安全使用实践的改善 医疗补助儿童。鉴于危害的危险 包括升高2型糖尿病风险，体重增加，高血糖，高脂血症和潜在的长期 对大脑发育的影响。安全证据和指南强调了几种主要安全使用的重要性 可以帮助减轻这些风险的实践，包括监测血糖和脂质；避免并发 使用多个不同的AP；非药理学心理健康服务的一线使用；并最大程度地减少使用 在学龄前儿童中。事先由AHRQ支持的项目导致了HEDIS/CMS质量指标 实践，但是它们的实施极为不一致。许多州倡议已实施 改善这些安全使用实践，但是替代策略增加安全使用的影响尚不清楚。 至关重要的是其影响的证据。我们将使用混合方法策略来识别和记录 国家实施安全使用计划；评估他们对安全使用指标的影响；研究因果 有效性的机制；并积极传播结果给国家决策者，健康计划， 临床社区和其他利益相关者。此过程将支持翻译，实施以及 改善各州的有效策略。我们将对系统级的全面分析 策略，使用全国调查和案例研究在8个有目的的采样状态中，以调查独特的 方法。我们将使用关键的线人访谈和系统文档审查来确定实施 时间表，策略，因果机制，障碍和解决方案以及使用的工具。然后我们将使用医疗补助 索赔数据以评估实施状态后有针对性实践的使用变更 系统级策略，使用差分差异，三差和其他建模策略。国家 那没有实施类似的举措将作为比较者。最后，我们将积极传播 使用积极的传播策略，向国家和利益相关者社区提供了证据信息的工具包 成功地用于先前的AHRQ支持的合作伙伴关系。将开发此工具包，以促进自我 评估和优先考虑改进计划，确定其他国家策略，并提供 质量改进和评估工具，以评估随着时间的推移有效性。证据发展和主动 传播将确保提供有效的系统改造过程的证据 并有效地用于改善各州服务的脆弱儿童人群的患者安全 医疗补助/芯片系统并减少与AP相关的危害。