An equity-focused intervention to improve care transitions for Medicaid insured individuals with co-occurring serious mental health

项目摘要 由医疗补助保险的患有并发严重精神疾病的人（即，抑郁症精神分裂症 双相情感障碍）在医疗住院后经历持续和增长的差异， 缺乏侧重于其过渡期护理需求的干预措施。我们的研究重点是适应的 THRIVE是一种以股权为中心的基于证据的干预措施，支持医疗补助保险的个人， 多种慢性疾病从医院转移到家中。THRIVE服务包括协调护理， 规范跨学科交流，解决医院后未满足的临床和社会需求 放电虽然有证据表明THRIVE参与者的出院后结果得到了有力的改善， 目前尚不清楚这些干预措施是否同样有益于患有和不患有SMI的患者。这个的目标 项目是适应，实施和评估繁荣，以确保适用于所有病人投保的医疗补助 包括同时发生SMI的患者。为了实现这一目标，我们建议进行I型混合 在一个新的研究中心进行的有效性-实施阶梯楔形分组随机对照试验（CRCT）15， 宾夕法尼亚大学雪松校区医院（HUP-雪松）。HUP-雪松是一个100床的少数民族 位于费城西部的服务医院，其中>50%的患者是医疗补助或双重医疗保险， 医疗保险这项研究代表了卫生服务研究人员、社区 顾问，卫生保健领导和工作人员在HUP雪松和宾夕法尼亚州医学在家里，并寻求作为其 主要目标是利用参与式方法调整THRIVE干预措施并评估背景 需要执行。本研究的第二个目标是检查利用结果的差异 (e.g.,再入院）与那些接受常规护理相比，SMI的THRIVE参与者之间。最后我们 将采用混合方法，通过参与者和临床医生的访谈和调查，以评估 干预的可接受性、适当性、可行性和成本。我们的研究和社区参与 卫生系统合作伙伴了解以公平为中心的框架，这将有助于强调系统， 可能产生不公平的政策和交付过程。如果我们的研究假设得到支持，我们将 不仅确定是否可以调整和实施以公平为导向的循证干预措施， 包括患有SMI的患者在内的医疗补助保险患者的需求，但我们也将揭示与 这些结果。我们的建议与AHRQ的目标一致，即开发和调整EFEBI， 最得不到充分服务的人口的声音和需求，并改变护理程序， 医疗保健系统。总的来说，这项研究的结果将为我们下一阶段的研究奠定基础。 研究，其中包括对基于股权的实施战略进行多地点评估，以扩大规模， 评估THRIVE不同的医院环境。

Project Summary People insured by Medicaid with a co-occurring serious mental illness (i.e., depression, schizophrenia, and bipolar disorder) experience persistent and growing disparities following medical hospitalizations and interventions that focus on their transitional care needs are lacking. Our study focuses on the adaptation of the THRIVE, an equity-focused evidenced based intervention that supports Medicaid-insured individuals with multiple chronic conditions transitioning from hospital to home. THRIVE services include coordinating care, standardizing interdisciplinary communication, and addressing unmet clinical and social needs following hospital discharge. While evidence suggests robust improvements in post-discharge outcomes for THRIVE participants, it remains unclear whether the interventions equally benefit patients with and without SMI. The goals of this project are to adapt, implement and evaluate THRIVE to ensure suitability for all patients insured by Medicaid including those with co-occurring SMI. To meet this goal, we propose the conduct of a Type I Hybrid effectiveness-implementation stepped wedge cluster randomized controlled trial (CRCT)15 at a new site, the Hospital of the University of Pennsylvania Cedar Campus (HUP-Cedar). HUP-Cedar is a 100-bed minority serving hospital located in West Philadelphia where >50% of patients are Medicaid or dually Medicare and Medicaid-insured. This study represents a three-way partnership among health services researchers, community advisors, and health care leadership and staff at HUP-Cedar and Penn Medicine at Home and seeks as its primary objective to leverage participatory methods to adapt the THRIVE intervention and evaluate the context required for implementation. A second objective for this study is to examine differences in the utilization outcomes (e.g., readmissions) between THRIVE participants with SMI compared to those receiving usual care. Finally, we will employ mixed methods approaches through participant and clinician interviews and surveys to evaluate the acceptability, appropriateness, feasibility and cost of the intervention. Our study and engagement with community and health system partners is informed equity centered frameworks that will help to emphasize the systems, policies and delivery process from which inequities might arise. If our study hypotheses are supported, we will identify not only if an equity-oriented evidence-based intervention can be adapted and implemented to meet the needs of Medicaid insured patients including those with SMI, but we will also uncover the factors associated with those results. Our proposal is well-aligned with AHRQ's goal to develop and adapt EFEBI's that prioritize the voices and needs of the most underserved populations and change care processes to accelerate equity within healthcare systems. Collectively, the results of this study will provide the foundation for the next phase of our research, which includes a multi-site evaluation of equity-based implementation strategies to scale and rigorously evaluate THRIVE diverse hospital settings.