Improving Care for Patients with Bipolar Disorder

描述（由申请人提供）：双相情感障碍与显著的个人和社会成本相关。许多这些成本和不良后果归因于共同发生的一般医疗条件。该R34应用程序的具体目标是调整和试点测试一种新的干预措施，以提高基于社区的网络模式健康计划设置中双相情感障碍患者的一般医疗和精神病护理质量。干预措施包括：1）心理健康分割水平的护理经理，以协调提供者之间的医疗和精神病护理，2）患者自我管理支持，以及3）适用于双相情感障碍患者的循证指南实施（例如，代谢综合征危险因素评估）。干预措施将采用创新的框架（分级管理，或PM）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干预措施核心要素定制的投入。将组织供应商和消费者焦点小组，以定制干预措施，并将设立一个跨职能小组，以完善技术手册和解决可持续性问题。该干预措施将在8个心理健康诊所进行试点测试：4个随机接受干预措施，4个接受加强常规护理。每个诊所的18名诊断为双相情感障碍的患者将随访1年（总计n=144）。主要结局包括接受符合指南的医疗和精神病护理。研究人员是一个经验丰富的团队，来自多个学科：组织行为学，实施研究，定性评估，全科医学，慢性病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，以促进在不同环境中适应和传播治疗模式。双相情感障碍患者受一般医疗条件的影响不成比例。由于许多患有双相情感障碍的人是社会的积极成员，治疗不足的医疗条件可能会导致由于错过工作和功能不良而增加的经济成本。虽然大多数人在精神健康分割环境中接受护理，但目前没有为网络模式健康计划设计的治疗模式，以改善双相情感障碍或其他精神障碍患者的一般医疗护理管理。总的来说，这项研究将告知一个创新的，R01干预，是概括到网络模型的健康计划在美国各地。

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.