Accelerating Utilization of CE Findings in Medicaid Mental Health

描述（由申请人提供）：在美国，国家医疗补助计划在提供心理健康服务方面发挥着核心作用，特别是对于低收入的青少年和患有严重精神疾病的成年人，他们的心理健康治疗通常不是最佳的，而且变化很大，通常没有明显的临床依据。在现有的网络伙伴关系的基础上，基于证据的治疗网络（NET）将汇集七个州的医疗补助计划，占全国医疗补助计划注册人数的33%，与来自罗格斯-哥伦比亚大学心理健康cert的专家和其他合作伙伴一起，组成一个联盟，将实施一项创新的，在为州医疗补助计划的受益者提供精神健康治疗时，增加循证临床和交付系统实践的多成分倡议。根据CE证据确定了十个特定的临床目标领域进行测量和干预：精神健康药物综合用药；抗精神病药物代谢风险的管理6岁以下儿童抗精神病药物的使用；服用抗精神病药物的剂量高于推荐剂量；利用适当的精神保健服务作为精神治疗的补充或替代办法；诊断与治疗的一致性；地域、提供者、种族/民族和其他缺乏临床依据的治疗；成人严重精神疾病患者治疗依从性的改善查明和预测高风险/高利用率受益人，并针对这些亚人群提供服务；由寄养青少年使用的安全有效的精神药物和心理健康服务。NET将通过实施高效的组织实践来改善这些临床目标领域的治疗实践，包括系统地利用行政和临床数据来监测和指导政策，系统地提供提供者反馈，多州网络以支持成功的创新在各州之间的转移，以及在各州内创建多机构，多利益相关者的高质量合作，以实现创新的多州，多方面的，数据驱动的CQI计划在每个州。我们将在合作国家建立一个质量改进工具的综合系统，包括基线和后续国家使用概况，以识别和跟踪治疗模式的变化；实施和系统地使用一套质量指标和利用这些指标的供应商反馈系统；建立多利益相关者质量协作机制，制定州质量改进计划，并在每个州制定持续的质量改进流程。结果将在全国范围内进行评价和传播。鉴于医疗补助计划在资助精神卫生保健方面的核心作用，以及受影响的大量受益人，NET的潜在影响是巨大的。

DESCRIPTION (provided by applicant): State Medicaid programs play a central role in the provision of mental health services in the U.S., particularly for lower-income youth and adults with severe mental illness, whose mental health treatment is often sub- optimal and varies widely, often without apparent clinical rationale. Building on an existing network partnership, the Network for Evidence Based Treatment (NET) will bring together seven state Medicaid programs accounting for 33% of Medicaid enrollment nationally, together with experts from the Rutgers-Columbia mental health CERTs and other partners, into a consortium that will implement an innovative, multi-component initiative to increase the utilization of evidence-based clinical and delivery system practices in the provision of mental health treatment for beneficiaries of state Medicaid programs. Ten specific clinical target areas have been identified for measurement and intervention based on CE evidence: mental health drug polypharmacy; management of metabolic risks of antipsychotics; antipsychotic utilization for children under age six; higher than recommended doses of antipsychotics; utilization of appropriate mental health services as a complement or alternative to psychotropic treatments; consistency between diagnoses and treatments; geographical, provider, racial/ethnic, and other treatment lacking clinical rationale; improvement of treatment adherence for adults with severe mental illness; identification and prediction of high risk/high utilization beneficiaries and targeting of services to these subpopulations; safe and effective psychotropic and mental health services use by foster care youth. The NET will improve treatment practices in these clinical target areas by implementing highly effective organizational practices including the systematic utilization of administrative and clinical data to monitor and guide policy, systematic provision of provider feedback, multi-state networking to support transfer of successful innovations across states, and creation of multi-agency, multi-stakeholder quality collaboratives within states in order to implement an innovative multi-state, multi-faceted, data-driven CQI program in each state. We will put into place in collaborating states an integrated system of quality improvement tools including baseline and follow-up state profiles of use to identify and track variation in treatment patterns; implementation and systematic use of a set of quality metrics and a system of provider feedback utilizing the metrics; and development of a multi-stakeholder quality collaborative, a state quality improvement plan, and a continuous quality improvement process in each state. Results will be evaluated and disseminated nationally. The potential impact of the NET is enormous given Medicaid's central role in financing mental health care, and the large number of beneficiaries affected. PUBLIC HEALTH RELEVANCE: State Medicaid programs play a central role in the provision of mental health services in the U.S., particularly for lower-income youth and adults with severe mental illness, whose mental health treatment is often sub- optimal and varies widely, often without apparent clinical rationale. Building on an existing network partnership, the Network for Evidence Based Treatment (NET) will bring together seven state Medicaid programs accounting for 33% of Medicaid enrollment nationally, together with experts from the Rutgers-Columbia mental health CERTs and other partners, into a consortium that will implement an innovative, multi-component initiative to increase the utilization of evidence-based clinical and delivery system practices in the provision of mental health treatment for beneficiaries of state Medicaid programs. We will put into place in collaborating states an integrated system of quality improvement tools including baseline and follow-up state profiles of use to identify and track variation in treatment patterns; implementation and systematic use of a set of quality metrics and a system of provider feedback utilizing the metrics; and development of a multi-stakeholder quality collaborative, a state quality improvement plan, and a continuous quality improvement process in each state. Results will be evaluated and disseminated nationally; the potential impact is extremely large given the large number of beneficiaries affected.