Improving Care for Patients with Bipolar Disorder

描述（由申请人提供）：双相情感障碍与重大的个人和社会成本相关。许多这些费用和不良后果归因于共同发生的一般医疗条件。本R34应用程序的具体目的是适应和试点测试一种新的干预措施，以提高社区网络模式健康计划设置中双相情感障碍患者的一般医疗和精神护理质量。干预措施包括：1)心理健康分离层面的护理经理，以协调医疗和精神科服务提供者之间的护理；2)患者自我管理支持；3)适用于双相情感障碍患者的循证指南实施（例如，代谢综合征风险因素评估）。干预措施将采用创新框架（参与式管理，简称PM）进行调整和标准化。项目管理涉及系统地整合来自涉众对干预的核心要素的定制的输入。将组织供应商和消费者焦点小组来定制干预措施，并将组建一个跨职能小组来完善技术手册并解决可持续性问题。干预措施将在八家精神卫生诊所进行试点试验：四家随机接受干预措施，四家接受加强的常规护理。每个诊所将对18名诊断为双相情感障碍的患者进行为期一年的随访（总n=144）。主要结局包括接受符合指南的医疗和精神护理。研究人员是一个来自多个学科的经验丰富的团队：组织行为学、实施研究、定性评估、普通医学、慢性护理模式干预和统计学。本研究与公共卫生的相关性：PM过程是一种促进在不同环境中适应和传播治疗模式的新方法。双相情感障碍患者受到一般医疗条件的影响不成比例。由于许多双相情感障碍患者是社会的活跃成员，治疗不足的医疗条件可能导致由于错过工作和功能不良而增加的经济成本。虽然大多数人在精神健康隔离环境中接受治疗，但目前还没有为网络模式健康计划设计的治疗模式，以改善对双相情感障碍或其他精神障碍患者的一般医疗护理管理。总的来说，这项研究将为一种创新的R01干预提供信息，这种干预可以推广到美国的网络模式健康计划中。

DESCRIPTION (provided by applicant): Bipolar disorder is associated with significant personal and societal costs. Many of these costs and adverse outcomes are attributed to co-occurring general medical conditions. The specific aims of this R34 application are to adapt and pilot test a novel intervention to improve the quality of general medical and psychiatric care for patients with bipolar disorder within a community-based, network-model health plan setting. The intervention includes: 1) a Care Manager at the mental health carve-out level to coordinate medical and psychiatric care across providers, 2) patient self-management support, and 3) evidence-based guideline implementation adapted for patients with bipolar disorder (e.g., metabolic syndrome risk factor evaluation). The intervention will be adapted and standardized using an innovative framework (Participatory Management, or PM). PM involves the systematic incorporation of input from stakeholders on the customization of an intervention's core elements. Provider and consumer focus groups will be conducted to customize the intervention, and a cross-functional team will be implemented to refine the technical manual and address sustainability issues. The intervention will be pilot tested in eight mental health clinics: four randomized to receive the intervention and four receiving enhanced usual care. Eighteen patients diagnosed with bipolar disorder from each clinic will be followed for one year (total n=144). Primary outcomes include receipt of guideline-concordant medical and psychiatric care. The investigators are an experienced team from multiple disciplines: organizational behavior, implementation research, qualitative assessment, general medicine, chronic care model interventions, and statistics. Relevance of this research to public health: The PM process is a novel approach to facilitate adaptation and dissemination of treatment models across different settings. Individuals with bipolar disorder are disproportionately affected by general medical conditions. Because many individuals with bipolar disorder are active members of society, undertreated medical conditions can lead to increased economic costs due to missed work and poor functioning. While the majority of individuals receive care in mental health carve-out settings, there are currently no treatment models designed for network-model health plans to improve the management of general medical care for patients with bipolar or other mental disorders. Overall, this study will inform an innovative, R01 intervention that is generalizable to network-model health plans across the United States.