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

以公平为重点的干预措施，以改善同时患有严重心理健康问题的医疗补助投保人的护理过渡

• 批准号: 10831712
• 负责人: JACQUELINE MARGO BROOKS CARTHON
• 金额: $ 49.78万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2026-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10831712
• 关键词: equity; focused; intervention; improve; care

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.

项目摘要 接受医疗补助保险的人同时患有严重精神疾病(如抑郁症、精神分裂症和 双相情感障碍)在住院治疗后经历持续和不断扩大的差距 缺乏以过渡时期护理需求为重点的干预措施。我们的研究主要集中在对语言的适应 Thrive，一个专注于股票和证据的干预措施，支持医疗补助保险的个人 多种慢性疾病从医院过渡到家庭。兴旺的服务包括协调护理， 规范跨学科交流，解决医院后未得到满足的临床和社会需求 出院。虽然有证据表明，Thrive参与者的出院后结果有了强劲的改善， 目前尚不清楚这些干预措施是否同样有利于患有和不患有SMI的患者。这样做的目的是 项目是适应、实施和评估Thrive，以确保适用于所有参加医疗补助的患者 包括那些同时发生SMI的患者。为了实现这一目标，我们建议进行I型混合动力 有效性-在新地点实施阶梯式楔形整群随机对照试验(CRCT)15， 宾夕法尼亚大学雪松校区医院(HUP-Cedar)。Hup-Cedar是一个拥有100个床位的少数民族 位于费城西部的一家服务医院，50%的患者参加了联邦医疗补助或双重医疗保险，并 医疗补助保险。这项研究代表了卫生服务研究人员、社区 HUP-Cedar和Penn Medicine at Home的顾问、医疗保健领导层和员工，并寻求将其 主要目标是利用参与性方法来适应Thrive干预和评估背景 实施所需的。这项研究的第二个目标是检查利用结果的差异 与那些接受常规护理的患者相比，患有SMI的Thrive参与者之间的差异(例如，重新入院)。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来评估 干预的可接受性、适当性、可行性和成本。我们的学习和与社区的接触 卫生系统合作伙伴是以公平为中心的知情框架，这将有助于强调系统， 可能出现不平等的政策和交付过程。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股权为导向的循证干预措施，以满足 医疗补助保险患者的需求，包括那些患有SMI的患者，但我们也将揭示与 那些结果。我们的建议与AHRQ的目标很好地结合在一起，即开发和调整EFEBI，将 最缺乏服务的人群的呼声和需求，并改变护理进程，以加快 医疗保健系统。总体而言，这项研究的结果将为我们下一阶段的 研究，其中包括对基于股权的实施战略进行多点评估，以扩大规模并严格 评估欣欣向荣的多样化医院环境。