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：
10666416
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/10666416
关键词：
Address Affordable Care Act Career Mobility Caring Characteristics Clinical Clinical Management Complex Continuity of Patient Care Contracts Data Data Analyses Data Linkages Data Set Dedications Development Development Plans Diagnosis Effectiveness Electronic Health Record Emergency department visit Ensure Environment Equilibrium Future Health Health Care Rationing Health Personnel 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 Policy Maker Population Primary Care Provider Psychiatrist Psychiatry Psychotherapy Quality of Care Regulation Research Research Methodology Research Personnel Resources Sampling Science 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 beneficiary care delivery care outcomes career career development density design electronic health data health care availability health care delivery health care service health care service utilization health plan hospital readmission improved interest learning strategy 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.

项目摘要/摘要候选人：Jane M. Zhu，医学博士，MPP，MSHP是一名初级保健实习生和卫生服务研究人员热衷于改善弱势群体获得医疗保健和健康成果的机会。她有一个对心理保健的特别兴趣。为了促进独立的职业，她寻求教学和经验培训以发展心理健康方面的主题专业知识；医疗补助的方法论专业知识对未来电子健康数据链接的索赔分析和培训；以及定性和混合方法技能。研究环境：提供商网络是健康计划所拥有的所有医疗保健提供者和设施的清单与其签约为其成员提供医疗服务。对什么特征几乎没有理解心理健康提供者网络对于提供高质量的护理持续监控和监管工作。这种需求在医疗补助中受到了放大，Medicaid是最大的精神保健付款人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善具有心理健康诊断的医疗补助受益人的护理利用和临床结果，以帮助启用卫生保健机构和政策制定者，以更有效地平衡增加获得的紧张局势公共保险计划面临的治疗和资源限制。具体目的：1）表征心理健康提供者网络的变化； 2A）测量关联提供者网络特征和护理利用模式和临床结果之间； 2b）评估提供者网络与护理利用模式和临床结果之间的差异关联患有严重精神疾病的受益人小组（SMI）； 3）确定护理输送因子如何与提供者网络解释心理保健利用模式和临床结果的变化。研究计划：为了实现这些目的，朱博士将学习并应用连续剥离的混合 - 从2014 - 2018年在俄勒冈州的医疗补助计划中利用网络变化的方法方法，结合了医疗补助行政索赔分析以及文档分析和网络内的定性访谈提供者。未来的R01将利用多国家样本来检查提供商网络变化的影响关于精神保健的质量，通过与电子健康记录相关的医疗补助分析提取物数据。职业发展计划：与她的导师紧密合作，朱博士将1）发展主题专业知识在精神健康覆盖范围和服务提供的设计和组织中； 2）获得方法论专业知识在分析医疗补助行政数据集以及基础培训以及补充基于索赔的基础培训的同时通过电子健康记录数据进行分析； 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，可以与专门致力于朱博士的成功和许多多学科机构的导师和合作者拥有生产成功的独立卫生服务调查员的记录。