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: 9980917
• 负责人: Stephen Crystal
• 金额: $ 38.5万
• 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 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980917
• 关键词: 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.

该项目将大规模解决抗精神病药物（AP）治疗的安全使用实践的改进 医疗补助儿童。鉴于以下危险，对受影响人进行安全和明智的管理提出了重大挑战 包括 2 型糖尿病风险升高、体重增加、高血糖、高脂血症以及潜在的长期 对大脑发育的影响。安全证据和指南强调了几个关键安全使用的重要性 有助于减轻这些风险的做法，包括监测血糖和血脂；避免并发 使用多个不同的 AP；一线使用非药物心理健康服务；并尽量减少使用 在学龄前儿童中。之前 AHRQ 支持的项目已经为这些项目制定了 HEDIS/CMS 质量指标 的做法，但其实施却高度不一致。许多国家举措已经实施 改进这些安全使用实践，但增加安全使用的替代策略的影响尚不清楚。 迫切需要证明其影响的证据。我们将使用混合方法策略来识别和记录 国家实施安全使用举措；评估它们对安全使用指标的影响；调查因果关系 有效性的机制；并积极向国家决策者、卫生计划、 临床社区和其他利益相关者。此过程将支持翻译、实施和 改进各州的有效战略。我们将提供系统级的全面分析 战略，利用在 8 个有目的地抽样的州进行的全国调查和案例研究，调查独特的 接近。我们将通过关键知情人访谈和系统文件审查来确定实施情况 时间表、战略、因果机制、障碍和解决方案以及所使用的工具。然后我们将使用医疗补助 索赔数据用于评估国家实施后目标做法使用的变化 系统级策略，使用双重差分、三重差分和其他建模策略。州 未实施类似举措的国家将作为比较对象。最后，我们将积极宣传 利用积极的传播策略，向国家和利益相关者社区提供循证工具包 曾成功参与过 AHRQ 支持的先前合作伙伴关系。该工具包的开发将促进自我 评估改进举措并确定优先顺序，确定其他国家战略，并提供 质量改进和评估工具，用于评估随时间推移的有效性。证据发展和积极 传播将确保有效系统改进过程的证据是可用的、可理解的、 并有效用于改善国家服务的弱势儿童群体的患者安全 医疗补助/CHIP 系统并减少与 AP 相关的危害。