Mental Health Spending and Quality of Care

心理健康支出和护理质量

• 批准号: 7679555
• 负责人: Thomas G. McGuire
• 金额: $ 55.46万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-26 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7679555
• 关键词: Address; Administrator; Affect; Area; Asthma; Attention; Bipolar Disorder; Budgets; California; Caring; Chronic Obstructive Airway Disease; Clinical Treatment; Congestive Heart Failure; Coronary Arteriosclerosis; Cost Control; Country; County; Data; Databases; Diabetes Mellitus; Disease; Disease model; Drug Prescriptions; Ensure; Etiology; Face; Florida; Funding; Geographic Distribution; Goals; Government; Health; Health Policy; Health Services Accessibility; Health Services Research; Health system; Healthcare; Healthcare Systems; Individual; Influentials; Leadership; Link; Literature; Major Depressive Disorder; Measures; Medicaid; Medical; Medicare; Mental Health; Mental Health Services; Mental disorders; Methods; Operative Surgical Procedures; Outcome; Pattern; Performance; Policies; Policy Maker; Policy Research; Province; Public Policy; Published Comment; Quality of Care; Reporting; Research; Research Personnel; Resources; Schizophrenia; Science; Series; Solutions; Variant; Work; cost; cost effective; economic impact; improved; meetings; programs; prototype; severe mental illness

DESCRIPTION (provided by applicant): Research on regional variation in spending and quality within Medicare has shown that higher levels of spending are not positively correlated with higher quality of care and in some cases are negatively correlated. These findings have led some to suggest that spending in many areas of the country can be reduced sharply without any meaningful loss in the quality of care. Such observations jeopardize public commitment to devoting resources to health care. The Director of the Congressional Budget Office in his testimony before the Senate Budget Committee in June of 2007 suggested that the weak link between variation in spending and quality pointed toward cost control opportunities that will not affect outcomes. Research aimed at understanding the links between variation in spending and quality is of central importance for public policy. Almost no attention has been given these issues in the area of mental health delivery. It is especially important to study these issues in the mental health arena since a larger share of mental health spending is borne by government (than for general medical care) and therefore the province of public policy. We propose to address these important issues by pursuing the following three specific aims. AIM 1: To use Medicaid claims data to define a series of quality, access and spending measures relevant to state policy for individuals with severe mental illness and other mental illnesses. We will characterize the variation in these measures and produce basic summaries of local mental health care system performance. Our empirical analysis will focus on longitudinal data from the states of Florida and California and put those patterns into a larger context by examining variation within 10 other state Medicaid programs. AIM 2: To estimate the causal link between quality and access and spending. We will estimate models of disease-specific spending at the individual level. We also compare the relationship of quality and spending indicators at the local level for mental illness to the relationships for other medical conditions including: diabetes, congestive heart failure (CHF), asthma, coronary artery disease, and chronic obstructive pulmonary disease (COPD). AIM 3: To propose and implement as a pilot a "County Mental Health System Report Card" for use by state mental health policy leadership. The Report Card will be developed with the aid of state Medicaid and mental health policy makers. This application focuses on one of the most critical policy research questions in health and mental health care: How do we understand observed variation in mental health spending, quality and access to care? Little is known about such variation in the mental health area. We expand methods of the science of variations and apply them to mental health care using data from the Medicaid program.

描述(由申请人提供)：对医疗保险中支出和质量的地区差异的研究表明，支出水平较高与医疗质量较高并不是正相关，在某些情况下是负相关的。这些发现导致一些人提出，在不造成任何有意义的医疗质量损失的情况下，该国许多地区的支出可以大幅减少。这些观点危及公众对将资源投入医疗保健的承诺。2007年6月，国会预算办公室主任在参议院预算委员会作证时表示，支出差异和质量之间的薄弱联系指向了不会影响结果的成本控制机会。旨在了解支出差异和质量之间联系的研究对公共政策至关重要。在精神卫生服务领域，这些问题几乎没有受到关注。在精神卫生领域研究这些问题尤其重要，因为精神卫生支出的更大份额由政府承担(比一般医疗费用更大)，因此是公共政策的范畴。我们建议通过追求以下三个具体目标来解决这些重要问题。目标1：使用医疗补助索赔数据来定义一系列与严重精神疾病和其他精神疾病患者的国家政策相关的质量、获取和支出措施。我们将描述这些措施的差异，并对当地精神卫生保健系统的绩效进行基本总结。我们的实证分析将重点放在佛罗里达州和加利福尼亚州的纵向数据上，并通过检查其他10个州医疗补助计划的差异，将这些模式置于更大的背景中。目标2：评估质量、可获得性和支出之间的因果联系。我们将在个人层面上估计疾病特定支出的模型。我们还比较了地方层面精神疾病的质量和支出指标与其他医疗疾病的关系，包括糖尿病、充血性心力衰竭(CHF)、哮喘、冠状动脉疾病和慢性阻塞性肺疾病(COPD)。目的3：提出并试点实施《县精神卫生系统成绩单》，供国家精神卫生政策领导使用。成绩单将在州医疗补助和精神健康政策制定者的帮助下开发。这项应用聚焦于健康和精神卫生保健中最关键的政策研究问题之一：我们如何理解观察到的精神卫生支出、质量和获得护理的机会的差异？人们对心理健康领域的这种差异知之甚少。我们扩展了变异科学的方法，并利用医疗补助计划的数据将其应用于精神卫生保健。