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

该项目将在规模上解决改善抗精神病药物(AP)治疗的安全使用做法 医疗补助儿童。安全和明智地管理AP会带来巨大的挑战，因为 包括2型糖尿病风险增加、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的安全使用的重要性 有助于降低这些风险的做法，包括监测血糖和血脂；避免并发 使用多个不同的AP；一线使用非药理学精神卫生服务；以及最大限度地减少使用 在学龄前儿童中。以前由AHRQ支持的项目已导致HEDIS/CMS为这些项目制定质量指标 这种做法，但其执行情况却非常不一致。许多州的倡议已经实施到 改进这些安全使用做法，但增加安全使用的替代战略的影响尚不清楚。 迫切需要关于它们影响的证据。我们将使用混合方法策略来识别和记录 说明安全使用倡议的实施情况；评估其对安全使用指标的影响；调查原因 有效的机制；并积极向国家决策者、保健计划、 临床社区和其他利益相关者。该流程将支持翻译、实施和 改善各州的有效战略。我们将提供系统级别的全面分析 战略，使用全国调查和在8个有目的地抽样的州进行的案例研究，以调查独特的 接近了。我们将使用关键线人访谈和系统的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 评估国家实施后目标做法使用情况的变化的索赔数据 系统级策略，采用差异法、三差法等建模策略。州政府 没有实施类似举措的国家将作为参照者。最后，我们将积极传播一个 向国家和利益攸关方社区提供循证工具包，利用积极的传播战略 在以前的AHRQ支持的伙伴关系中成功使用。此工具包将被开发为促进自我 评估和确定改进举措的优先顺序，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。证据开发和主动性 传播将确保关于有效的系统改进过程的证据是可用的、理解的、 并有效地用于改善州政府服务的弱势儿童群体的患者安全 医疗补助/芯片系统，减少与AP相关的危害。

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.