Continuity of Medication Management in Medicaid

描述(由申请人提供)：共病的心脏代谢健康状况是精神分裂症患者健康的重大负担，是发病率和死亡率的主要来源。尽管他们有负担，但有证据表明，提供者对精神分裂症患者的共病问题处理不力。这种管理不善的一个经常被引用的原因是，处理患者心理健康需求的精神科专家和处理其他症状的初级保健提供者之间的护理协调不力。对于服用药物来管理精神分裂症和合并健康状况的患者，糟糕的护理协调可能会导致不适当的处方、重复的药物治疗、药物不遵守，以及更积极的卫生服务利用，用于高支出密集型资源，如住院和急诊室接诊。这项研究是在研究团队先前工作的基础上进行的，目的是更好地了解跨多个护理环境的医疗补助人群中药物管理(COMM)的连续性，以及严重的精神健康状况(精神分裂症)对COMM的作用。这项研究的第一个目的是检查为患有一种或多种心脏代谢疾病的医疗补助患者提供药物的处方数量和类型，以及精神分裂症对这种关系的影响。这一目标将确定参与患者护理的提供者的数量和类型的程度，以确定护理协调机会。第二个目标将比较由一名精神病学家和单一初级保健提供者共同管理的精神分裂症患者和使用多个精神科提供者和/或多个初级保健提供者的患者的服药依从性和卫生服务利用情况。这一目标的结果将检验精神病学家和初级保健医生之间的共同管理对健康结果的影响，而不是由可能重复治疗的多个提供者进行糟糕的管理。最终的研究目标将检验疗养院在改善AIM 2中共同患病患者的健康结果方面的效果。如果患者有以下两种或两种以上的慢性健康状况：高血压、高脂血症、糖尿病和/或精神分裂症，则纳入研究。具体的比较将在患有慢性心脏代谢疾病的患者和没有精神分裂症的患者之间进行。该研究使用医疗补助分析摘录(MAX)的4个州(科罗拉多州、肯塔基州、北卡罗来纳州和佛蒙特州)的索赔数据来解决这些问题。将使用每种药物类别的药物拥有率来评估服药依从性，卫生服务利用情况的比较将仅限于高强度服务(住院和急诊科就诊)。这项研究将提高我们对药物护理协调、心理健康在护理协调中的作用以及医疗之家模式在改善对多种慢性病患者的护理方面的好处的理解。

DESCRIPTION (provided by applicant): Comorbid cardiometabolic health conditions are a significant burden to the health of patients with schizophrenia representing a major source of morbidity and mortality. Despite their burden, there is evidence to suggest that providers poorly manage comorbid problems in patients with schizophrenia. One oft-cited reason for this mismanagement is poor care coordination between psychiatric specialists treating the mental health needs of patients and primary care providers managing other symptoms. For patients taking medications to manage schizophrenia and comorbid health conditions, poor care coordination can result in inappropriate prescribing, duplication of medication therapy, medication non-adherence, and more aggressive health service utilization for high expenditure intensive resources such as inpatient hospitalizations and emergency room encounters. This study extends upon prior work performed by the research team to better understand continuity of medication management (COMM) in a Medicaid population across multiple care settings and the role that a severe mental health condition (schizophrenia) has on COMM. The first aim of this study is to examine the number and types of prescribers providing medications for Medicaid patients with one or more cardiometabolic conditions and the influence of schizophrenia on this relationship. This aim will identify the extent of the number of providers and types of providers involved in patient care to target care coordination opportunities. The second aim will compare medication adherence and health service utilization in patients with schizophrenia and one or more cardiometabolic health conditions receiving comanagement by a single psychiatrist and single primary care provider to patients using multiple psychiatric providers and/or multiple primary care providers. The results of this aim will examine the influence of comanagement between psychiatrists and PCPs on health outcomes in comparison to poor comanagement by multiple providers potentially duplicating treatment. The final study aim will examine the effect o the medical home at improving health outcomes among patients that are comanaged in aim 2. Patients will be included in the study if they have 2 or more of the following chronic health conditions: hypertension, hyperlipidemia, diabetes, and/or schizophrenia. Specific comparisons will be made between patients with a chronic cardiometabolic health condition with and without schizophrenia. The study uses Medicaid Analytical eXtract (MAX) claims data for 4 states with well validated prescriber information in prescription claims (Colorado, Kentucky, North Carolina, and Vermont) to address these questions. Medication adherence will be assessed using the Medication Possession Ratio for each of the medication classes used and health service utilization comparisons will be limited to high intensive services (inpatient admissions and emergency department visits). This study will improve our understanding of medication care coordination, the role of mental health in care coordination, and the benefits of the medical home model at improving care for patients with multiple chronic conditions.