Advancing Patient Safety for Antipsychotic-Treated Children: Examining State Implementation of Safe Use Practices

该项目将大规模地改善抗精神病药（AP）治疗的安全使用实践， 医疗补助儿童。鉴于危害， 包括2型糖尿病、体重增加、高血糖症、高脂血症和潜在长期 影响大脑发育。安全证据和指南强调了几个关键安全使用的重要性 有助于缓解这些风险的实践，包括监测血糖和血脂;避免并发 使用多种不同的AP;一线使用非药物心理健康服务;以及尽量减少使用 在学龄前儿童中。之前AHRQ支持的项目已经导致HEDIS/CMS质量指标， 实践，但它们的执行是高度不一致的。许多州的倡议已经实施， 改进这些安全使用做法，但增加安全使用的替代策略的影响尚不清楚。 迫切需要关于其影响的证据。我们将使用混合方法策略来识别和记录 说明安全使用倡议的实施情况;评估其对安全使用指标的影响;调查因果关系 有效性的基础机制;并积极向国家决策者、卫生计划、 临床社区和其他利益相关者。该流程将支持翻译、实施和 改善各国的有效战略。我们将提供系统级的全面分析 战略，使用全国调查和案例研究，在8个有目的的抽样国家，调查独特的 接近。我们将使用关键的线人访谈和系统的文件审查，以确定实施 时间表、战略、因果机制、障碍和解决办法以及所使用的工具。然后我们将使用医疗补助 索赔数据，以评估在实施国家 系统级策略，使用差异中的差异、三重差异和其他建模策略。国 没有实施类似举措的国家将作为比较对象。最后，我们将积极宣传 利用积极传播战略，向国家和利益攸关方社区提供循证工具包 成功地应用于以前由人权事务高级专员办事处支持的伙伴关系。开发该工具包的目的是促进自我- 评估和优先考虑改进措施，确定其他国家战略，并提供 质量改进和评估工具，以评估一段时间内的有效性。证据开发和活跃 传播将确保有效的系统改进过程的证据是可获得的、可理解的， 并有效地用于改善各州所服务的弱势儿童群体的患者安全 医疗补助/芯片系统，并减少AP相关的伤害。

This project will address, at scale, improvement of safe use practices for antipsychotic (AP) treatment of Medicaid children. Safe and judicious management of APs poses significant challenges, given hazards that include elevated risk of Type 2 diabetes, weight gain, hyperglycemia, hyperlipidemia, and potential long-term impact on brain development. Safety evidence and guidelines highlight the importance of several key safe-use practices that can help mitigate these risks, including monitoring blood glucose and lipids; avoiding concurrent use of multiple different APs; first-line use of non-pharmacological mental health services; and minimizing use among pre-school children. Prior AHRQ-supported projects have led to HEDIS/CMS quality metrics for these practices, but their implementation is highly inconsistent. Many state initiatives have been implemented to improve these safe-use practices, but the impact of alternative strategies for increasing safe-use is unknown. Evidence on their effects is critically needed. We will use a mixed-methods strategy to identify and document state implementation of safe-use initiatives; assess their impact on safe use metrics; investigate causal mechanisms underlying effectiveness; and actively disseminate results to state decisionmakers, health plans, clinical communities, and other stakeholders. This process will support translation, implementation, and improvement of effective strategies across states. We will provide a comprehensive analysis of systems-level strategies, using a national survey and case studies in 8 purposively sampled states, to investigate distinctive approaches. We will use key informant interviews and systematic document review to identify implementation timelines, strategies, causal mechanisms, barriers and solutions, and tools utilized. We will then use Medicaid claims data to assess change in the use of the targeted practices following the implementation of state systems-level strategies, using difference-in-difference, triple-difference and other modeling strategies. States that did not implement similar initiatives will serve as comparators. Finally, we will actively disseminate an evidence-informed toolkit to state and stakeholder communities, utilizing active dissemination strategies successfully employed in prior AHRQ-supported partnerships. This toolkit will be developed to facilitate a self- assessment and prioritization of improvement initiatives, identification of other state strategies, and provide quality improvement and evaluation tools to assess effectiveness over time. Evidence development and active dissemination will assure that evidence on effective system-improvement processes is available, understood, and effectively used to improve patient safety across populations of vulnerable children served by state Medicaid/CHIP systems and reduce AP-related harms.