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 由医疗补助与同时发生的严重精神疾病（即抑郁症，精神分裂症和 双相情感障碍）经历了医疗住院和 缺乏关注其过渡护理需求的干预措施。我们的研究重点是适应 Thrive是一种基于股票的基于股票的干预措施 多个慢性病从医院过渡到家。蓬勃发展的服务包括协调护理， 标准化跨学科沟通，并在医院后解决未满足的临床和社会需求 释放。虽然证据表明，蓬勃发展的参与者的分期后结局有效改善，但 目前尚不清楚干预措施是否同样受益于有或没有SMI的患者。目标的目标 项目将适应，实施和评估蓬勃发展，以确保对医疗补助保险的所有患者适用 包括具有同时发生SMI的人。为了实现这一目标，我们提出了I型混合动力的行为 有效性实施梯级楔形集群随机对照试验（CRCT）15在新站点，即 宾夕法尼亚大学锡达校园（HUP-CEDAR）医院。 Hup-cedar是100张床的少数民族 位于费城西费城的服务医院，> 50％的患者是医疗补助或双重医疗保险 医疗补助保险。这项研究代表了卫生服务研究人员，社区之间的三向伙伴关系 Hup-Cedar和Penn Medicine的顾问，医疗保健领导和员工在家中 利用参与方法来适应繁荣干预并评估背景的主要目标 实施所需。这项研究的第二个目标是检查利用结果的差异 （例如，再入院）与接受常规护理的参与者相比，具有SMI的繁荣参与者之间。最后，我们 将通过参与者和临床医生访谈和调查采用混合方法的方法来评估 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互动 卫生系统合作伙伴是以股权为中心的知情框架，将有助于强调系统， 可能出现不平等的政策和交付过程。如果支持我们的研究假设，我们将 不仅确定是否可以调整和实施以股权为基础的循证干预措施 医疗补助保险的患者的需求在内，包括患有SMI的患者，但我们还将发现与 这些结果。我们的建议与AHRQ的目标相结合，以开发和适应Efebi的优先级优先级。 服务最不足的人群的声音和需求，并改变护理过程，以加速公平 医疗保健系统。总的来说，这项研究的结果将为我们的下一阶段奠定基础 研究，其中包括对基于公平的实施策略进行多站点评估，以进行严格的扩展 评估繁荣的多元化医院环境。