Improving Care for Patients with Bipolar Disorder

描述(由申请人提供)：双相情感障碍与巨大的个人和社会成本有关。这些费用和不良后果中的许多都归因于共同发生的一般医疗条件。此R34应用程序的具体目标是适应和试点测试一种新的干预措施，以在基于社区的网络模式健康计划环境中提高双相情感障碍患者的一般医疗和精神护理质量。干预措施包括：1)在精神健康创业层面设立护理经理，以协调不同提供者的医疗和精神护理；2)患者自我管理支持；3)适用于双相情感障碍患者的循证指南实施(例如，代谢综合征风险因素评估)。将使用一个创新的框架(参与式管理，或PM)对干预措施进行调整和标准化。项目管理涉及系统地纳入利益攸关方对定制干预核心要素的投入。将组织供应商和消费者重点小组，以定制干预措施，并将实施一个跨职能小组，以完善技术手册并解决可持续性问题。这项干预措施将在八家心理健康诊所进行试点测试：四家随机接受干预，四家接受加强的日常护理。对每所门诊确诊的18例双相情感障碍患者进行为期一年的随访(共144例)。主要结果包括接受符合指南的医疗和精神护理。研究人员是来自多个学科的经验丰富的团队：组织行为学、实施研究、定性评估、全科医学、慢性护理模式干预和统计学。这项研究与公共卫生的相关性：PM过程是一种新的方法，可以促进治疗模式在不同环境中的适应和传播。双相情感障碍患者受一般医疗条件的影响不成比例。由于许多双相情感障碍患者都是活跃的社会成员，医疗条件不佳可能会因缺勤和功能不良而导致经济成本增加。虽然大多数人在精神健康创业环境中接受护理，但目前还没有为网络模式健康计划设计的治疗模式，以改善对双相情感障碍或其他精神障碍患者的一般医疗护理的管理。总体而言，这项研究将为一种创新的R01干预提供信息，该干预可推广到全美的网络模式健康计划。

DESCRIPTION (provided by applicant): Bipolar disorder is associated with significant personal and societal costs. Many of these costs and adverse outcomes are attributed to co-occurring general medical conditions. The specific aims of this R34 application are to adapt and pilot test a novel intervention to improve the quality of general medical and psychiatric care for patients with bipolar disorder within a community-based, network-model health plan setting. The intervention includes: 1) a Care Manager at the mental health carve-out level to coordinate medical and psychiatric care across providers, 2) patient self-management support, and 3) evidence-based guideline implementation adapted for patients with bipolar disorder (e.g., metabolic syndrome risk factor evaluation). The intervention will be adapted and standardized using an innovative framework (Participatory Management, or PM). PM involves the systematic incorporation of input from stakeholders on the customization of an intervention's core elements. Provider and consumer focus groups will be conducted to customize the intervention, and a cross-functional team will be implemented to refine the technical manual and address sustainability issues. The intervention will be pilot tested in eight mental health clinics: four randomized to receive the intervention and four receiving enhanced usual care. Eighteen patients diagnosed with bipolar disorder from each clinic will be followed for one year (total n=144). Primary outcomes include receipt of guideline-concordant medical and psychiatric care. The investigators are an experienced team from multiple disciplines: organizational behavior, implementation research, qualitative assessment, general medicine, chronic care model interventions, and statistics. Relevance of this research to public health: The PM process is a novel approach to facilitate adaptation and dissemination of treatment models across different settings. Individuals with bipolar disorder are disproportionately affected by general medical conditions. Because many individuals with bipolar disorder are active members of society, undertreated medical conditions can lead to increased economic costs due to missed work and poor functioning. While the majority of individuals receive care in mental health carve-out settings, there are currently no treatment models designed for network-model health plans to improve the management of general medical care for patients with bipolar or other mental disorders. Overall, this study will inform an innovative, R01 intervention that is generalizable to network-model health plans across the United States.