Preventable Mortality in Maryland Medicaid SMI

马里兰州医疗补助 SMI 中的可预防死亡率

• 批准号: 7559571
• 负责人: Gail L. Daumit
• 金额: $ 11.85万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-01-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7559571
• 关键词: 21 year old; Acute; Administrative Supplement; Admission activity; Adult; Adverse event; Aftercare; Age; Alcohol abuse; Alcohols; American; Area; Arts; Attention; Bipolar Disorder; Caring; Cause of Death; Cessation of life; Chronic; Chronic Disease; Chronic lung disease; Colorado; Communities; Coronary Arteriosclerosis; Crossover Design; Data; Diabetes Mellitus; Diagnosis; Disabled Persons; Disease; Enrollment; Event; Excess Mortality; Failure; Frequencies; Funding; General Hospitals; General Population; Goals; Health; Heart Diseases; Hospital Mortality; Hospital Records; Hospitalization; Hospitals; Hypertension; Injury; Inpatients; Intervention; Interview; Length of Stay; Life Expectancy; Longevity; Major Depressive Disorder; Malignant Neoplasms; Maryland; Medicaid; Medical; Medical Errors; Methodology; Morbidity - disease rate; Operative Surgical Procedures; Outpatients; Participant; Patients; Persons; Pharmaceutical Preparations; Pharmacy facility; Population; Psyche structure; Quality of Care; Relative Risks; Research; Research Personnel; Retrospective Studies; Risk; Sampling; Schizophrenia; Secondary Prevention; Substance abuse problem; Time; Utah; base; cohort; comparison group; design; directed attention; follow-up; high risk; improved; indexing; innovation; instrument; longitudinal analysis; mortality; patient population; patient safety; premature; prevent; safety study; severe mental illness; suicide rate

DESCRIPTION (provided by applicant): Excess mortality among persons with severe mental illness (SMI) is documented consistently, yet higher suicide rates only partially explain this mortality difference. Previous research has focused little attention on the contribution of somatic disease or poor quality care to mortality in persons with SMI, who likely are at higher risk than others for poorer quality care, including adverse events. This study will utilize and extend an existing NIMH-funded community-based cohort of 6,235 adults with SMI, ages 21-62 in 1993, enrolled in Maryland Medicaid, and followed from fiscal years 1994-2000. Matching to the National Death Index revealed over 18% (N=1142) have died at a mean age of only 51 years. This magnitude of early mortality, almost 3 times the expected rate for Maryland residents, is alarming. A retrospective study is proposed to examine potentially preventable causes of mortality in persons with SMI. In Maryland Medicaid cohorts of 6,235 adults with SMI and 30,000 disabled adults without SMI our Specific Aims are: 1) Estimate the relative risk of mortality from specific health problems (alcohol and substance abuse, injury and chronic medical conditions); 2) Examine the relative risk of mortality associated with poor quality of care for coronary artery disease, diabetes, schizophrenia, bipolar disorder and major depression. In the SMI cohort we will then: 3) Examine the risk of in-hospital mortality or mortality within 30 days of hospital discharge associated with the occurrence of adverse events in medical and surgical hospitalizations; and 4) Compare the occurrence and types of adverse events to a completed state-of-the art patient safety study of admissions to general hospitals. Specific Aims 1 and 2 will implement a longitudinal analysis of Medicaid administrative data through 2004 and apply quality of care indicators for chronic conditions. Specific Aim 3 will use a case-crossover design where adverse events from hospital records around the time of death will be compared to those in a randomly selected earlier hospitalization for the same subject. Specific Aim 4 will compare adverse event data in Specific Aim 3 to a patient safety study in the general population using the same chart abstraction instrument. This innovative study will illuminate factors contributing to premature death in the SMI that may be amenable to improved quality of care, and/or improved patient safety, and will provide a basis for prioritizing interventions to improve longevity in the SMI.

描述（由申请人提供）：严重精神疾病（SMI）患者死亡率过高的情况得到一致记录，但较高的自杀率只能部分解释这种死亡率差异。先前的研究很少关注躯体疾病或低质量护理对 SMI 患者死亡率的影响，他们可能比其他人面临更高质量的护理（包括不良事件）的风险。这项研究将利用并扩展由 NIMH 资助的现有社区队列，该队列由 6,235 名患有 SMI 的成年人组成，他们于 1993 年加入马里兰州医疗补助计划，并从 1994 年至 2000 财年进行跟踪研究。与全国死亡指数匹配显示，超过 18% (N=1142) 的人死亡时平均年龄仅为 51 岁。这种早期死亡率几乎是马里兰州居民预期死亡率的三倍，令人震惊。建议进行一项回顾性研究，以检查 SMI 患者死亡的潜在可预防原因。在马里兰州医疗补助队列中，有 6,235 名患有 SMI 的成年人和 30,000 名没有 SMI 的残疾成年人，我们的具体目标是： 1) 估计特定健康问题（酒精和药物滥用、受伤和慢性疾病）导致死亡的相对风险； 2) 检查与冠状动脉疾病、糖尿病、精神分裂症、双相情感障碍和重度抑郁症护理质量差相关的死亡相对风险。在 SMI 队列中，我们将： 3) 检查与内科和外科住院期间不良事件发生相关的院内死亡或出院 30 天内死亡的风险； 4) 将不良事件的发生和类型与已完成的综合医院入院患者安全研究进行比较。具体目标 1 和 2 将实施对 2004 年医疗补助管理数据的纵向分析，并应用慢性病护理质量指标。具体目标 3 将采用病例交叉设计，将死亡前后医院记录中的不良事件与同一受试者随机选择的早期住院记录中的不良事件进行比较。具体目标 4 将使用相同的图表抽象工具将具体目标 3 中的不良事件数据与一般人群中的患者安全研究进行比较。这项创新研究将阐明导致 SMI 过早死亡的因素，这些因素可能有助于提高护理质量和/或改善患者安全，并将为优先采取干预措施以提高 SMI 寿命提供基础。