Improving Evidence-based Behavioral, Somatic and Social Service Delivery for SMI

 描述(由申请人提供)：严重精神病患者(SMI)是美国最脆弱的人群之一，他们经历着严重的过早死亡，高比例的慢性疾病并存，以及负面的社会后果，如失业和无家可归。这一人口每年给社会造成的损失估计为3170亿美元，而重度精神障碍患者是社会保障残疾受益人中规模最大、增长最快的亚群体。NIMH的战略计划、医学研究所和SAMHSA都强调将降低SMI患者的死亡率作为优先事项。尽管这一群体对医疗保健和社会服务的需求很高，但大多数患有SMI的人没有得到符合指南的躯体或行为保健或以证据为基础的社会服务，如支持性就业。NIMH K01指导型研究科学家发展奖的重新提交申请旨在支持约翰霍普金斯大学彭博公共卫生学院的一位新助理教授，他渴望通过在不同的环境中增加对这一群体的循证医疗和社会服务的接受和持续提供，来改善SMI患者的健康和社会结果。McGinty博士的博士工作和之前的研究都集中在SMI患者的护理质量和刑事司法问题上。她的直接职业目标是：1)获得必要的知识和技能，以评估组织和提供者层面的因素，这些因素促进和阻碍了SMI循证医疗和社会服务的提供；以及2)获得评估战略所需的知识和技能，以协调为SMI患者提供的躯体、行为和社会服务。通过K01，McGinty博士将加深对医疗保健提供系统的了解，并在实施研究方面获得新的知识和技能，特别是在定性研究和多层次建模方面的新技能。拟议的研究将采用混合方法，在马里兰州的医疗补助健康之家计划的背景下，研究针对重度精神障碍患者的循证医疗保健和社会服务的实施情况。健康之家的实施要求交付组织和提供者从根本上改变他们的使命，从只在他们的专业领域内提供护理转向为有SMI的“全人”提供综合保健。协调这些零散的服务带来了一系列实施挑战，因此在这种情况下研究为SMI患者提供循证服务至关重要。通过提供工资支持、培训、免除行政责任和正式的指导结构，该奖项将促进McGinty博士过渡到专注于改善SMI患者的健康和社会结果的独立研究职业生涯。

 DESCRIPTION (provided by applicant): Persons with serious mental illness (SMI) are one of the most vulnerable populations in the US, experiencing significant premature mortality, high rates of co-morbid chronic conditions, and negative social outcomes such as unemployment and homelessness. This population costs society an estimated $317 billion per year, and persons with SMI are the largest and fastest growing subgroup of social security disability beneficiaries. NIMH's Strategic Plan, the Institute of Medicine and SAMHSA all emphasize decreasing mortality for persons with SMI as priorities. Despite the high need for healthcare and social services in this group, most persons with SMI do not receive guideline-concordant somatic or behavioral healthcare or evidence-based social services, such as supported employment. This resubmission application for a NIMH K01 mentored research scientist development award seeks support for a new Assistant Professor at the Johns Hopkins Bloomberg School of Public Health who aspires to a career focused on improving health and social outcomes for persons with SMI by increasing uptake and sustained delivery of evidence-based healthcare and social services for this group in diverse settings. Dr. McGinty's doctoral work and prior research has focused on quality of care and criminal justice issues in persons with SMI. Her immediate career objectives are to: 1) Gain the knowledge and skills needed to assess organization and provider-level factors that facilitate and impede delivery of evidence-based healthcare and social services for SMI; and 2) Gain the knowledge and skills needed to evaluate strategies to coordinate delivery of somatic, behavioral, and social services for persons with SMI. Through this K01, Dr. McGinty will gain enhanced understanding of healthcare delivery systems and new knowledge and skills in implementation research, specifically new skills in qualitative research and multilevel modeling. The proposed research will employ mixed methods to study implementation of evidence- based healthcare and social services for persons with SMI in the context of the Medicaid health homes program in Maryland. Health home implementation requires delivery organizations and providers to fundamentally shift their missions away from solely providing care within their specialty areas to providing integrated healthcare for the "whole person" with SMI. Coordinating these fragmented services presents a host of implementation challenges, making it critically important to study uptake and sustained delivery of evidence-based services for persons with SMI in this context. By providing salary support, training, freedom from administrative responsibilities, and a formal mentorship structure, this award will facilitate Dr. McGinty's transition to an independent research career focused on improving health and social outcomes among persons with SMI.