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Mental Health Provider Networks in Medicaid and Implications for Care Utilization and Health Outcomes

医疗补助中的心理健康提供者网络及其对护理利用和健康结果的影响

基本信息

批准号：
10443785
负责人：
Jane Mingjia Zhu
金额：
$ 18.9万
依托单位：
OREGON HEALTH & SCIENCE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10443785
关键词：
Address Affordable Care Act Caring Characteristics Clinical Clinical Management Complex Continuity of Patient Care Contracts Data Data Analyses Data Linkages Data Set Development Development Plans Diagnosis Effectiveness Electronic Health Record Emergency department visit Ensure Environment Equilibrium Foundations Future Health Health Personnel Health Sciences Health Services Health Services Accessibility Health care facility Health system Healthcare Hospitalization Improve Access Institution Insurance Claim Review Internist Interview Knowledge Learning Link Literature Location Managed Care Programs Measures Medicaid Medical Mental Health Mental Health Services Mental disorders Mentors Mentorship Methodology Methods Monitor Oregon Outcome Overdose Patient-Focused Outcomes Patients Pattern Pharmaceutical Preparations Physicians Population Primary Health Care Provider Psychiatrist Psychiatry Psychotherapy Quality of Care Regulation Research Research Methodology Research Personnel Resources Sampling Scientist Self-Injurious Behavior Statutes and Laws Structure Subgroup Time Training Travel United States Centers for Medicare and Medicaid Services Universities Variant Vulnerable Populations Work barrier to care base beneficiary care delivery care outcomes career career development density design health care availability health care delivery health care service health care service utilization health data health plan hospital readmission improved interest medical specialties member mental health organization multidisciplinary parity programs provider networks public health insurance service delivery severe mental illness skills social success suicide rate tool

项目摘要

Project Summary/Abstract Candidate: Jane M. Zhu, MD, MPP, MSHP is a primary care internist and health services researcher who is passionate about improving access to health care and health outcomes for vulnerable populations. She has a particular interest in mental health care. To advance her career towards independence, she seeks didactic and experiential training to develop subject matter expertise in mental health; methodologic expertise in Medicaid claims analysis and training for future electronic health data linkages; and qualitative and mixed methods skills. Research Context: A provider network is a list of all health care providers and facilities that a health plan has contracted with to provide medical care to its members. There is little understanding of what characteristics of mental health provider networks are important for providing high-quality care despite ongoing monitoring and regulation efforts. This need is magnified in Medicaid, one of the largest payers for mental health care in the U.S. This proposal seeks to understand which key modifiable characteristics of provider networks can improve care utilization and clinical outcomes for Medicaid beneficiaries with mental health diagnoses, to help enable health care institutions and policymakers to more effectively balance the tensions between increased access to treatment and the resource constraints faced by a public insurance program. Specific Aims: 1) Characterize variation in mental health provider networks; 2a) Measure the association between provider network characteristics and care utilization patterns and clinical outcomes; 2b) Assess differential associations between provider networks and care utilization patterns and clinical outcomes in a sub- group of beneficiaries with severe mental illness (SMI); 3) Identify how care delivery factors interface with provider networks to explain variations in mental health care utilization patterns and clinical outcomes. Research Plan: To accomplish these aims, Dr. Zhu will learn and apply a sequential explanatory mixed- methods approach that leverages network variation from 2014-2018 in Oregon’s Medicaid program, combining Medicaid administrative claims analysis with document analysis and qualitative interviews of in-network providers. A future R01 will utilize a multi-state sample to examine the impact of variation in provider networks on quality of mental health care, via Medicaid Analytic eXtract data linked to electronic health records. Career Development Plan: Working closely with her mentors, Dr. Zhu will 1) develop subject matter expertise in the design and organization of mental health coverage and service delivery; 2) gain methodologic expertise in analyzing Medicaid administrative datasets alongside foundational training in supplementing claims-based analyses with electronic health record data; and 3) develop skills in qualitative and mixed methods research. Environment: Oregon Health and Science University offers an ideal environment to pursue this training, with well-established mentors dedicated to Dr. Zhu’s success and a number of multi-disciplinary institutions and collaborators with a track record of producing successful, independent health services investigators.

项目总结/摘要候选人：简M。朱，医学博士，MPP，MSHP是一个初级保健内科医生和卫生服务研究员谁是热衷于改善弱势群体获得医疗保健和健康成果的机会。她有一对心理健康特别感兴趣。为了推动她的职业生涯走向独立，她寻求说教，体验式培训，以发展心理健康方面的主题专业知识;医疗补助中的方法学专业知识索赔分析和培训，以便今后建立电子保健数据联系;以及定性和混合方法技能。研究背景：提供者网络是健康计划拥有的所有医疗保健提供者和设施的列表与其签约为其成员提供医疗服务。人们对这种生物的特征知之甚少，精神卫生提供者网络对于提供高质量的护理非常重要，尽管正在进行监测，监管努力。这种需求在医疗补助中被放大，医疗补助是美国精神卫生保健的最大支付者之一。美国该提案旨在了解提供商网络的哪些关键可修改特征可以改进有精神健康诊断的医疗补助受益人的护理利用率和临床结果，卫生保健机构和决策者更有效地平衡增加获得治疗和公共保险计划面临的资源限制。具体目标：1）描述心理健康提供者网络的变化; 2a）测量相关性提供者网络特征与护理利用模式和临床结果之间的关系; 2b）评估提供者网络和护理利用模式之间的差异关联和亚临床结果严重精神疾病受益人群体（SMI）; 3）确定护理提供因素如何与提供者网络来解释精神卫生保健利用模式和临床结果的变化。研究计划：为了实现这些目标，朱博士将学习和应用顺序解释混合- 该方法利用俄勒冈州医疗补助计划2014-2018年的网络变化，结合医疗补助行政索赔分析与文件分析和定性访谈的网络提供商未来的R 01将利用多个州的样本来检查供应商网络变化的影响通过与电子健康记录相关联的Medicaid Analytic eXtract数据，职业发展计划：与导师紧密合作，朱博士将1）发展专业知识在精神卫生覆盖和服务提供的设计和组织; 2）获得方法学专业知识在分析医疗补助管理数据集的同时，电子健康记录数据分析; 3）发展定性和混合方法研究的技能。环境：俄勒冈州健康与科学大学提供了一个理想的环境，以追求这一培训，致力于朱博士成功的知名导师和一些多学科机构，合作者与生产成功的，独立的卫生服务调查的跟踪记录。