Statewide Intervention to Reduce Early Mortality in Persons with Mental Illness

描述(申请人提供)：2009年9月，新罕布夏州社区精神卫生中心(CMHC)将开始在全州范围内分阶段实施一项突破性的预防性干预措施，解决与严重精神疾病(SMI)患者肥胖相关的心脏代谢紊乱相关的关键风险因素。这类疾病导致该人群的寿命缩短了20%。该干预措施包括两个部分：(1)激励健康促进计划(HP)，包括帮助SMI患者实现更好的体力活动、营养、戒烟和自我效能的“健康指导”；(2)学术详细干预(AD)，将针对使用Medicaid药房的处方者，声称鼓励减少使用高体重增加倾向的抗精神病药物和减少使用多药联用。NH实施这种双成分干预(健康促进+学术详细说明，HP+AD)是基于两个正在进行的随机、联邦资助的有效性试验的有希望的结果试点数据，以及最近NH州医疗补助报销办公室批准将健康促进作为一项综合精神健康服务。这项自然实验的评估将使用两种方法：1)对4家CMHC的120名消费者及其处方者的样本进行个人水平的结果评估(目标1)。两个早期实施(HP+AD)CMHC和两个晚期(通常护理)CMHC的结果将进行比较，包括健康行为、健康指标、精神症状、自我效能、急性卫生服务利用、处方实践、计划忠诚度和计划成本。2)与惠普+AD干预相关的系统级结果评估(目标2)，因为它是由该州的10家CMHC从健康导师记录审查和医疗补助索赔中分阶段实施的，包括消费者健康行为、健康指标、急性医疗服务利用、处方实践和计划忠诚度。这项建议响应了NIMH的战略计划优先事项，用Insel主任的话说，就是“减少精神病患者的过早死亡率”。这一自然实验提供了一个史无前例的、时间敏感的机会来评估全州范围内针对SMI患者的健康促进计划对公共健康的影响，这是一个潜在的模式，可以降低全国范围内由州精神卫生系统服务的SMI患者的早期死亡率。2.关联性。患有严重精神疾病的人平均比普通人群年轻约25岁，主要是因为与肥胖相关的疾病，如心脏病和糖尿病。新罕布夏州即将启动一项计划，鼓励患有严重精神疾病的人进行锻炼、更健康的饮食和戒烟(这是医疗补助计划主要覆盖的第一个此类计划)，并敦促他们的医生减少开出导致体重增加和其他缩短寿命的副作用的药物。我们建议跟踪这一州计划的结果，以便为其他州类似的未来努力吸取有用的经验教训。 公共卫生相关性：患有严重精神疾病的人平均比普通人群年轻约25岁，主要是由于与肥胖相关的疾病，如心脏病和糖尿病。新罕布夏州即将启动一项计划，鼓励患有严重精神疾病的人进行锻炼、更健康的饮食和戒烟(这是医疗补助计划主要覆盖的第一个此类计划)，并敦促他们的医生减少开出导致体重增加和其他缩短寿命的副作用的药物。我们建议跟踪这一州计划的结果，以便为其他州类似的未来努力吸取有用的经验教训。

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.