Statewide Intervention to Reduce Early Mortality in Persons with Mental Illness

描述（由申请人提供）：2009年9月，新罕布什尔州的社区精神健康中心（CMHCs）将开始分阶段实施一项开创性的、全州范围的预防性干预措施，针对严重精神疾病（SMI）患者中与肥胖相关的心血管代谢紊乱相关的关键风险因素。这些疾病导致这一群体的寿命缩短了20%。干预有两个组成部分：(1)一个由“健康指导”组成的激励健康促进计划（HP），以帮助重度精神障碍患者改善身体活动、营养、戒烟和自我效能；(2)一个学术详细干预（AD），针对使用医疗补助药房声明的处方者，鼓励减少使用高增重倾向的抗精神病药物和减少使用多种药物。NH实施这种双组分干预（健康促进+学术详细说明，HP+AD）是基于两项正在进行的随机的、联邦资助的有效性试验的有希望的结果试点数据，以及NH州医疗补助办公室最近批准的将健康促进作为一种综合心理健康服务进行报销。对这一自然实验的评估将采用双组分方法：1)对4家cmhc的120名消费者及其开处方者进行个人水平的结果评估（目标1）。两种早期实施（HP+AD） cmhc和两种晚期实施（常规护理）cmhc的比较结果包括健康行为、健康指标、精神症状、自我效能感、急性卫生服务利用、处方实践、项目保真度和项目成本。2)系统级评估与HP+AD干预相关的结果（目标2），因为它是由国家的10个CMHCs从健康导师记录审查和医疗补助索赔中逐步实施的，包括消费者健康行为、健康指标、急性卫生服务利用、处方实践和计划保真度。该提案回应了NIMH战略计划的优先事项，用Insel主任的话来说，“减少精神疾病患者的过早死亡”。这个自然实验提供了一个前所未有的、时间敏感的机会来评估全州范围内的重度精神障碍患者健康促进计划对公共卫生的影响，这是一个潜在的模型，可以减少由全国各州精神卫生系统服务的重度精神障碍患者的早期死亡率。2. 的相关性。患有严重精神疾病的人比一般人平均少死25岁，主要是因为与肥胖有关的疾病，如心脏病和糖尿病。新罕布什尔州即将启动一项计划，鼓励患有严重精神疾病的人锻炼、健康饮食和戒烟（这是第一个主要由医疗补助计划覆盖的此类计划），并敦促他们的医生少开会导致体重增加和其他缩短寿命的副作用的药物。我们建议跟踪这个州项目的结果，以便为其他州今后类似的努力吸取有益的经验教训。

DESCRIPTION (provided by applicant): In September 2009, New Hampshire's community mental health centers (CMHCs) will begin phased implementation of a groundbreaking, statewide, preventive intervention addressing critical risk factors associated with obesity-related cardio metabolic disorders in persons with serious mental illness (SMI). Such disorders contribute to a 20% shorter lifespan in that group. The intervention has two components: (1) A motivational health-promotion program (HP) consisting of "health mentoring" to assist persons with SMI in achieving improved physical activity, nutrition, smoking cessation, and self-efficacy, and (2) an academic detailing intervention (AD) that will target prescribers using Medicaid pharmacy claims to encourage decreased use of antipsychotic agents with high weight-gain propensity and decreased use of polypharmacy. NH's implementation of this two-component intervention (health promotion plus academic detailing, HP+AD) is based on promising outcome pilot data from two ongoing randomized, federally-funded effectiveness trials and recent approval by the NH State Office of Medicaid reimbursement for health promotion as an integrated mental health service. The evaluation of this natural experiment will use a two-component approach: 1) Person-level assessment of outcomes (Aim 1) for a sample of 120 consumers and their prescribers in 4 CMHCs. Outcomes to be compared between two early-implementation (HP+AD) CMHCs and two late- implementation (usual care) CMHCs include health behaviors, health indicators, psychiatric symptoms, self-efficacy, acute health service utilization, prescribing practices, program fidelity, and program costs. 2) System-level assessment of outcomes (Aim 2) associated with the HP+AD intervention as it is phased-in by the State's 10 CMHCs from health mentor record review and Medicaid claims, including consumer health behaviors, health indictors, acute health service utilization, prescribing practices, & program fidelity. This proposal responds to the NIMH's Strategic Plan priority to, in the words of Director Insel, "reduce premature mortality among persons with mental illness." This natural experiment presents an unprecedented, time-sensitive opportunity to evaluate the public-health impact of a statewide health promotion program for persons with SMI, which is a potential model for reducing early mortality for persons SMI served by state mental-health systems nationwide. 2. Relevance. People with serious mental illness die about 25 years younger on average than the general population, mostly because of obesity-related disorders such as heart disease and diabetes. New Hampshire is about to start a program encouraging exercise, healthier diet, and stopping smoking for people with serious mental illness (the first such program mostly covered by Medicaid) and to urge their doctors to prescribe fewer medications that cause weight gain and other life-shortening side effects. We propose to track the outcomes of this state program so that useful lessons can be drawn for similar, future efforts in other states. PUBLIC HEALTH RELEVANCE: People with serious mental illness die about 25 years younger on average than the general population, mostly because of obesity-related disorders such as heart disease and diabetes. New Hampshire is about to start a program encouraging exercise, healthier diet, and stopping smoking for people with serious mental illness (the first such program mostly covered by Medicaid) and to urge their doctors to prescribe fewer medications that cause weight gain and other life-shortening side effects. We propose to track the outcomes of this state program so that useful lessons can be drawn for similar, future efforts in other states.