Accelerating Utilization of CE Findings in Medicaid Mental Health

描述（由申请人提供）：州医疗补助计划在美国提供心理健康服务方面发挥着核心作用，特别是对于患有严重精神疾病的低收入青年和成年人，他们的精神健康治疗往往不是最佳的，而且差异很大，往往没有明显的临床理由。基于现有的网络合作伙伴关系，循证治疗网络（NET）将汇集七个州医疗补助计划，占全国医疗补助注册人数的33%，以及来自罗格斯-哥伦比亚大学心理健康CERT和其他合作伙伴的专家，组成一个联盟，将实施一个创新的，多组成部分的倡议，以增加利用循证临床和交付系统的做法，提供心理健康治疗的受益人的国家医疗补助计划。根据CE证据确定了10个具体的临床目标领域进行测量和干预：精神健康药物多种用药;抗精神病药物代谢风险的管理; 6岁以下儿童的抗精神病药物使用;高于推荐剂量的抗精神病药物;使用适当的精神健康服务作为精神病治疗的补充或替代;诊断和治疗之间的一致性;地理、提供者、种族/民族和其他缺乏临床理由的治疗;改善严重精神疾病成人的治疗依从性;确定和预测高风险/高利用率受益人，并将服务目标对准这些亚群;寄养青年安全有效地使用精神和心理健康服务。NET将通过实施高效的组织实践来改善这些临床目标领域的治疗实践，包括系统地利用行政和临床数据来监测和指导政策，系统地提供者反馈，支持跨州成功创新转移的多州网络，以及创建多机构，各州内的多利益相关者质量合作，以便在每个州实施创新的多州，多方面，数据驱动的CQI计划。我们将在合作州建立一个质量改进工具的综合系统，包括用于识别和跟踪治疗模式变化的基线和后续状态配置文件;实施和系统使用一套质量指标和利用指标的提供者反馈系统;在每个州建立一个多利益相关者质量合作组织、一个州质量改进计划和一个持续的质量改进过程。将对结果进行评估并在全国范围内传播。NET的潜在影响是巨大的，因为医疗补助计划在资助精神卫生保健方面发挥着核心作用，而且受影响的受益者人数众多。 公共卫生相关性：州医疗补助计划在美国提供精神卫生服务方面发挥着核心作用，特别是对于患有严重精神疾病的低收入青年和成年人，他们的精神健康治疗往往不是最佳的，而且差异很大，往往没有明显的临床理由。基于现有的网络合作伙伴关系，循证治疗网络（NET）将汇集七个州医疗补助计划，占全国医疗补助注册人数的33%，以及来自罗格斯-哥伦比亚大学心理健康CERT和其他合作伙伴的专家，组成一个联盟，将实施一个创新的，多组成部分的倡议，以增加利用循证临床和交付系统的做法，提供心理健康治疗的受益人的国家医疗补助计划。我们将在合作州建立一个质量改进工具的综合系统，包括用于识别和跟踪治疗模式变化的基线和后续状态配置文件;实施和系统使用一套质量指标和利用指标的提供者反馈系统;在每个州建立一个多利益相关者质量合作组织、一个州质量改进计划和一个持续的质量改进过程。将对结果进行评估并在全国范围内传播;鉴于受影响的受益者众多，潜在影响极大。

DESCRIPTION (provided by applicant): State Medicaid programs play a central role in the provision of mental health services in the U.S., particularly for lower-income youth and adults with severe mental illness, whose mental health treatment is often sub- optimal and varies widely, often without apparent clinical rationale. Building on an existing network partnership, the Network for Evidence Based Treatment (NET) will bring together seven state Medicaid programs accounting for 33% of Medicaid enrollment nationally, together with experts from the Rutgers-Columbia mental health CERTs and other partners, into a consortium that will implement an innovative, multi-component initiative to increase the utilization of evidence-based clinical and delivery system practices in the provision of mental health treatment for beneficiaries of state Medicaid programs. Ten specific clinical target areas have been identified for measurement and intervention based on CE evidence: mental health drug polypharmacy; management of metabolic risks of antipsychotics; antipsychotic utilization for children under age six; higher than recommended doses of antipsychotics; utilization of appropriate mental health services as a complement or alternative to psychotropic treatments; consistency between diagnoses and treatments; geographical, provider, racial/ethnic, and other treatment lacking clinical rationale; improvement of treatment adherence for adults with severe mental illness; identification and prediction of high risk/high utilization beneficiaries and targeting of services to these subpopulations; safe and effective psychotropic and mental health services use by foster care youth. The NET will improve treatment practices in these clinical target areas by implementing highly effective organizational practices including the systematic utilization of administrative and clinical data to monitor and guide policy, systematic provision of provider feedback, multi-state networking to support transfer of successful innovations across states, and creation of multi-agency, multi-stakeholder quality collaboratives within states in order to implement an innovative multi-state, multi-faceted, data-driven CQI program in each state. We will put into place in collaborating states an integrated system of quality improvement tools including baseline and follow-up state profiles of use to identify and track variation in treatment patterns; implementation and systematic use of a set of quality metrics and a system of provider feedback utilizing the metrics; and development of a multi-stakeholder quality collaborative, a state quality improvement plan, and a continuous quality improvement process in each state. Results will be evaluated and disseminated nationally. The potential impact of the NET is enormous given Medicaid's central role in financing mental health care, and the large number of beneficiaries affected. PUBLIC HEALTH RELEVANCE: State Medicaid programs play a central role in the provision of mental health services in the U.S., particularly for lower-income youth and adults with severe mental illness, whose mental health treatment is often sub- optimal and varies widely, often without apparent clinical rationale. Building on an existing network partnership, the Network for Evidence Based Treatment (NET) will bring together seven state Medicaid programs accounting for 33% of Medicaid enrollment nationally, together with experts from the Rutgers-Columbia mental health CERTs and other partners, into a consortium that will implement an innovative, multi-component initiative to increase the utilization of evidence-based clinical and delivery system practices in the provision of mental health treatment for beneficiaries of state Medicaid programs. We will put into place in collaborating states an integrated system of quality improvement tools including baseline and follow-up state profiles of use to identify and track variation in treatment patterns; implementation and systematic use of a set of quality metrics and a system of provider feedback utilizing the metrics; and development of a multi-stakeholder quality collaborative, a state quality improvement plan, and a continuous quality improvement process in each state. Results will be evaluated and disseminated nationally; the potential impact is extremely large given the large number of beneficiaries affected.