Mental Health Provider Networks in Medicaid and Implications for Care Utilization and Health Outcomes

医疗补助中的心理健康提供者网络及其对护理利用和健康结果的影响

• 批准号: 10029659
• 负责人: Jane Mingjia Zhu
• 金额: $ 18.9万
• 依托单位: OREGON HEALTH & SCIENCE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10029659
• 关键词: Address; Affordable Care Act; Caring; Characteristics; Clinical; Clinical Management; Complex; Continuity of Patient Care; Contracts; Data; Data Analyses; Data Linkages; Data Set; Development; Development Plans; Diagnosis; Effectiveness; Electronic Health Record; Emergency department visit; Ensure; Environment; Equilibrium; Foundations; Future; Health; Health Personnel; Health Sciences; Health Services; Health Services Accessibility; Health care facility; Health system; Healthcare; Hospitalization; Improve Access; Institution; Insurance Claim Review; Internist; Interview; Knowledge; Learning; Link; Literature; Location; Managed Care Programs; Measures; Medicaid; Medical; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Methodology; Methods; Monitor; Oregon; Outcome; Overdose; Patient-Focused Outcomes; Patients; Pattern; Pharmaceutical Preparations; Physicians; Population; Primary Health Care; Provider; Psychiatrist; Psychiatry; Psychotherapy; Quality of Care; Regulation; Research; Research Methodology; Research Personnel; Resources; Sampling; Scientist; Self-Injurious Behavior; Statutes and Laws; Structure; Subgroup; Time; Training; Travel; United States Centers for Medicare and Medicaid Services; Universities; Variant; Vulnerable Populations; Work; barrier to care; base; beneficiary; care delivery; care outcomes; career; career development; density; design; health care availability; health care delivery; health care service; health care service utilization; health data; health plan; hospital readmission; improved; interest; medical specialties; member; mental health organization; multidisciplinary; parity; programs; provider networks; public health insurance; service delivery; severe mental illness; skills; social; success; suicide rate; tool

Project Summary/Abstract Candidate: Jane M. Zhu, MD, MPP, MSHP is a primary care internist and health services researcher who is passionate about improving access to health care and health outcomes for vulnerable populations. She has a particular interest in mental health care. To advance her career towards independence, she seeks didactic and experiential training to develop subject matter expertise in mental health; methodologic expertise in Medicaid claims analysis and training for future electronic health data linkages; and qualitative and mixed methods skills. Research Context: A provider network is a list of all health care providers and facilities that a health plan has contracted with to provide medical care to its members. There is little understanding of what characteristics of mental health provider networks are important for providing high-quality care despite ongoing monitoring and regulation efforts. This need is magnified in Medicaid, one of the largest payers for mental health care in the U.S. This proposal seeks to understand which key modifiable characteristics of provider networks can improve care utilization and clinical outcomes for Medicaid beneficiaries with mental health diagnoses, to help enable health care institutions and policymakers to more effectively balance the tensions between increased access to treatment and the resource constraints faced by a public insurance program. Specific Aims: 1) Characterize variation in mental health provider networks; 2a) Measure the association between provider network characteristics and care utilization patterns and clinical outcomes; 2b) Assess differential associations between provider networks and care utilization patterns and clinical outcomes in a sub- group of beneficiaries with severe mental illness (SMI); 3) Identify how care delivery factors interface with provider networks to explain variations in mental health care utilization patterns and clinical outcomes. Research Plan: To accomplish these aims, Dr. Zhu will learn and apply a sequential explanatory mixed- methods approach that leverages network variation from 2014-2018 in Oregon’s Medicaid program, combining Medicaid administrative claims analysis with document analysis and qualitative interviews of in-network providers. A future R01 will utilize a multi-state sample to examine the impact of variation in provider networks on quality of mental health care, via Medicaid Analytic eXtract data linked to electronic health records. Career Development Plan: Working closely with her mentors, Dr. Zhu will 1) develop subject matter expertise in the design and organization of mental health coverage and service delivery; 2) gain methodologic expertise in analyzing Medicaid administrative datasets alongside foundational training in supplementing claims-based analyses with electronic health record data; and 3) develop skills in qualitative and mixed methods research. Environment: Oregon Health and Science University offers an ideal environment to pursue this training, with well-established mentors dedicated to Dr. Zhu’s success and a number of multi-disciplinary institutions and collaborators with a track record of producing successful, independent health services investigators.

项目摘要/摘要 候选人：Jane M. Zhu，医学博士，MPP，MSHP是一名初级保健实习生和卫生服务研究人员 热衷于改善弱势群体获得医疗保健和健康成果的机会。她有一个 对心理保健的特别兴趣。为了促进独立的职业，她寻求教学和 经验培训以发展心理健康方面的主题专业知识；医疗补助的方法论专业知识 对未来电子健康数据链接的索赔分析和培训；以及定性和混合方法技能。 研究环境：提供商网络是健康计划所拥有的所有医疗保健提供者和设施的清单 与其签约为其成员提供医疗服务。对什么特征几乎没有理解 心理健康提供者网络对于提供高质量的护理持续监控和 监管工作。这种需求在医疗补助中受到了放大，Medicaid是最大的精神保健付款人之一 美国该提案旨在了解提供商网络的哪些关键可修改特征可以改善 具有心理健康诊断的医疗补助受益人的护理利用和临床结果，以帮助启用 卫生保健机构和政策制定者，以更有效地平衡增加获得的紧张局势 公共保险计划面临的治疗和资源限制。 具体目的：1）表征心理健康提供者网络的变化； 2A）测量关联 提供者网络特征和护理利用模式和临床结果之间； 2b）评估 提供者网络与护理利用模式和临床结果之间的差异关联 患有严重精神疾病的受益人小组（SMI）； 3）确定护理输送因子如何与 提供者网络解释心理保健利用模式和临床结果的变化。 研究计划：为了实现这些目的，朱博士将学习并应用连续剥离的混合 - 从2014 - 2018年在俄勒冈州的医疗补助计划中利用网络变化的方法方法，结合了 医疗补助行政索赔分析以及文档分析和网络内的定性访谈 提供者。未来的R01将利用多国家样本来检查提供商网络变化的影响 关于精神保健的质量，通过与电子健康记录相关的医疗补助分析提取物数据。 职业发展计划：与她的导师紧密合作，朱博士将1）发展主题专业知识 在精神健康覆盖范围和服务提供的设计和组织中； 2）获得方法论专业知识 在分析医疗补助行政数据集以及基础培训以及补充基于索赔的基础培训的同时 通过电子健康记录数据进行分析； 3）发展定性和混合方法研究的技能。 环境：俄勒冈州健康与科学大学提供了一个理想的环境，可以与 专门致力于朱博士的成功和许多多学科机构的导师和 合作者拥有生产成功的独立卫生服务调查员的记录。