Statewide Implementation of Health Homes for SMI:Building Research Infrastructure

描述（由申请人提供）：与总人口相比，患有严重精神疾病（SMI）的人的死亡率是总人口的两到三倍以上，主要死于医疗原因。然而，他们往往面临获得适当初级保健的挑战。根据《平价医疗法案》健康之家条款，各州可以获得联邦配套资金，用于筛查、协调、提供和监测包括重度精神障碍在内的弱势群体的医疗和精神卫生保健。马里兰州计划在2013年年中启动该计划，重点关注精神康复项目，作为健康之家的提供者，为有高服务需求的重度精神障碍患者提供服务。保健之家的核心组成部分将包括综合护理管理、护理协调、个性化治疗计划、社区资源联系和卫生信息技术的使用。通过R24，我们有独特的机会从马里兰州健康之家倡议开始研究这个自然实验。我们的研究团队在卫生政策、改善重度精神障碍患者整体健康的干预研究、实施科学和医疗补助数据分析方面具有高素质的专业知识。我们与马里兰州卫生和心理卫生部门以及心理健康提供者利益相关者合作，提出以下具体目标：1)开发和分析具有重度精神障碍的医疗补助接受者队列，以评估初级保健的使用和质量；2)评估利益相关者对康复计划中健康之家的感知需求和意图，以及组织因素；3)向利益相关者提供技术援助，重点是a)形成学习协作；B)健康促进活动的指导和提供者之间的成功协调；c)培训卫生院工作人员收集体重、BMI、血压、腰围和过期一氧化碳的研究质量测量数据。在社区的研究测量中嵌入专业知识是高度创新的，并将提供在未来评估中利用的重要能力。完成本R24的目标将为未来的R01提供有价值的初步工作和良好的基础，以严格评估马里兰州的健康之家倡议，其目标是改善SMI的医疗保健和健康结果。

DESCRIPTION (provided by applicant): Persons with serious mental illness (SMI) have two to over three times the mortality rate compared to the overall population, primarily dying of medical causes. Yet, they often face challenges accessing appropriate primary care. Under the Affordable Care Act Health Home provision, states may receive federal matching funds for screening, coordinating, providing, and monitoring medical and mental health care for vulnerable populations including SMI. Maryland plans to commence the initiative in mid-2013, focusing on psychiatric rehabilitation programs, serving SMI with high need for services, as providers of the health home. Core components of the health home will include comprehensive care management, care coordination, individualized treatment plans, community resource linkages and use of health information technology. Through this R24, we have the unique opportunity to study this natural experiment from the inception of Maryland's health home initiative. Our research team is highly qualified with expertise in health policy, intervention studies to improve overall health in SMI, implementation science and analysis of Medicaid data. In partnership with the Maryland Department of Health and Mental Hygiene and mental health provider stakeholders, we propose the following Specific Aims: 1) Develop and analyze a cohort of Medicaid recipients with SMI to assess use and quality of primary care; 2) Assess stakeholders' perceived needs and intentions, and organizational factors with regard to health homes in rehabilitation programs and 3) Provide technical assistance to stakeholders focusing on a) formation of a learning collaborative; b) guidance on health promotion activities and successful coordination among providers; and c) training health home staff to collect research quality measurements for weight, BMI, blood pressure, waist circumference and expired carbon monoxide. Embedding expertise in research measurements in the community is highly innovative and will provide an important capability to leverage in a future evaluation. Accomplishing the aims in this R24 will provide valuable preliminary work and an excellent foundation for a future R01 to rigorously evaluate Maryland's health home initiative with goals to improve health care and health outcomes in SMI.