Evaluation of the Rhode Island Health Home Initiative

罗德岛州健康之家计划的评估

基本信息

批准号：
9130510
负责人：
Michael Flores
金额：
$ 3.46万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-04-15 至 2017-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9130510
关键词：
Accident and Emergency department Address Affect Affordable Care Act Ambulatory Care Behavioral Caring Chronically Ill Communities Community Mental Health Centers Control Groups Data Decision Making Effectiveness Effectiveness of Interventions Emergency department visit Evaluation Event Expert Opinion Funding Funding Opportunities Goals Health Health Care Costs Health Policy Health Services Health Services Accessibility Healthcare Healthcare Systems Home Care Services Home environment Hospitalization Individual Inequality Intervention Knowledge Life Expectancy Medicaid Medical Mental Health Mental Health Services Mental disorders Mentally Ill Persons Methods Mission Modeling Morbidity - disease rate National Institute of Mental Health Outcome Outcome Study Outpatients Participant Patient-Centered Care Peer Review Persons Policy Developments Population Control Primary Health Care Prospective Studies Provider Public Health Quality of Care Research Research Design Research Priority Resources Review Literature Rhode Island Risk Services Strategic Planning Testing Work beneficiary care delivery community setting cost effective efficacy trial evidence base experience follow-up health care quality health disparity improved innovation medical attention medical specialties mortality patient population programs public health relevance research study severe mental illness trend

项目摘要

DESCRIPTION (provided by applicant): To address health disparities and inappropriate service use experienced by individuals with serious mental illness, there is a critical need to evaluate approaches that integrate primary care within specialty mental health settings to improve care access and health outcomes. Numerous studies have shown the benefits of integrated care. However, only limited research demonstrates the best approaches and settings to integrate health services for the seriously mentally ill. The long-term goal is to understand how health care integration for the seriously mentally ill can improve quality of care and health outcomes. The overall objective is to examine service use and quality of care before and after the introduction of a Health Home Initiative. Using longitudinal administrative data from both the Health Home Initiative and the Medicaid program, integration strategies implemented in community mental health centers that employed diverse care delivery models (coordinated, colocated, integrated) can be compared. The central hypothesis is that the Health Home Initiative alone, and in consort with an integrated care delivery model, can increase access to outpatient services, decrease potentially avoidable service use and improve quality of care. Findings from efficacy trials and expert opinion support this hypothesis. The rationale for the proposed research is that understanding the study outcomes will inform and guide policymakers as well as states implementing similar initiatives. The central hypothesis will be tested by pursing the following two aims: 1) Determine the extent to which Health Homes impacted service use and quality of care; and 2) Identify how care model setting affected service use and quality of care for Health Home participants. To complete these aims innovative analytic methods will be used to conduct a quasi- experimental research design, which allows for causal inferences. Propensity score matching will be used to achieve conditional exchangeability between the treatment and control populations; and a difference-in- differences analysis to control for confounding trends attributed to exogenous events that may obscure true effects. The proposed research will contribute to the understanding of approaches that integrate primary care into community mental health settings. This contribution will be significant as it is expected to provide evidence that can guide policy development and treatment decisions for health care systems and providers working with a heavily disenfranchised patient population. Completion of the aims will not only help to determine the impact of Health Homes on service use and quality of care, but identify the care setting (i.e. coordination, colocation, or integrated) most amenable to integration strategies. Moreover, the Health Home Initiative, which took place in a real-world setting, allows our findings to be more relevant than those from efficacy trials for healthcare decision making by providers and policymakers.

描述（由适用提供）：解决患有严重精神疾病的人经历的健康差异和不适当的服务使用，迫切需要评估将初级保健整合到专业心理健康环境中的方法，以改善护理访问和健康结果。大量研究表明了综合护理的好处。但是，只有有限的研究证明了为严重精神病患者综合卫生服务的最佳方法和设置。长期目标是了解严重精神病的医疗保健整合如何改善护理和健康成果的质量。总体目标是在引入健康之家计划之前和之后检查服务使用和护理质量。可以使用来自Health Home倡议和Medicaid计划的纵向行政数据，可以比较在社区心理健康中心实施的集成策略，这些策略使用潜水员护理交付模型（协调，共同，集成）。中心假设是，仅卫生之家倡议，并且与综合护理交付模式一致，可以增加获得门诊服务的机会，减少潜在的可避免的服务使用并提高护理质量。效率试验和专家意见的发现支持了这一假设。拟议的研究的理由是，了解研究成果将为决策者以及实施类似倡议的国家提供信息。中心假设将通过追求以下两个目的来检验：1）确定卫生屋影响服务使用和护理质量的程度； 2）确定如何设定护理模型对卫生家庭参与者的服务使用和护理质量。为了完成这些目标，将使用创新的分析方法来进行准实验研究设计，将使用倾向得分匹配来实现治疗群体和对照人群之间的条件交换性；以及差异分析，以控制归因于可能掩盖真实影响的外源性事件的混杂趋势。拟议的研究将有助于理解将初级保健纳入社区心理健康环境的方法。这项贡献将很重要提供可以指导医疗保健系统的政策制定和治疗决策的证据，以及与受人权的患者人群一起工作的提供者。目的的完成不仅将有助于确定卫生屋对服务使用和护理质量的影响，而且还确定最适合的护理设置（即协调，托管或整合）集成策略。此外，在现实世界中进行的《卫生之家倡议》使我们的发现比提供者和政策制定者进行医疗保健决策的有效试验的发现更为重要。