The New York City Mental Health Care Monitoring Initiative uses Medicaid claims data to identify individuals with serious mental illness who are experiencing or at risk for gaps in services. In this study the authors assessed whether proposed service use algorithms accurately identified such individuals.
A random sample of 500 individuals with serious mental illness was identified. Individuals belonged to specific high-need cohorts and met predefined claims-based criteria for potential service gaps. Clinical staff initiated reviews with prior service providers for 230 individuals.
Over a two-week period staff completed reviews for 188 cases (88%). In 66 cases (35%) the individual was fully engaged in care; 84 (45%) had a recent episode of disengagement that was appropriately addressed, and 38 (20%) were not receiving adequate services.
The proposed service use algorithms successfully identified high-need individuals with serious mental illness at risk for gaps in services.
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"Ultimately, Standard REP and Enhanced REP were well-matched to the implementation of Re-Engage because the components were designed to be employed across multiple sites via internet and phone, which enhances the potential for scalability. This approach also allowed for the rollout of implementation strategies on a national level, thus potentially saving travel and personnel costs55565758. Nonetheless, we found that Enhanced compared to REP did not result in an increased proportion of patients returning to care or increased utilization of services among those who had dropped out of care. "
"The Chronic Care Model is a population-and measurement-based approach that calls for healthcare organizations to use electronic registries to monitor vulnerable populations and to adjust treatment according to patient response. Not only has this model of care been successful in managing mental health across various healthcare settings [9,10], a number of large healthcare providers including the Veterans Health Administration (VA) have demonstrated that this model of care is effective for re-engaging persons with SMI who had been lost to care to prevent adverse health effects111213. Despite the promise of the Chronic Care Model and similar population management programs, they are rarely routinely implemented in practice [14,15]. "
[Show abstract][Hide abstract]ABSTRACT: Persons with serious mental illness are disproportionately burdened by premature mortality. This disparity is exacerbated by poor continuity of care with the health system. The Veterans Health Administration (VA) developed Re-Engage, an effective population-based outreach program to identify veterans with SMI lost to care and to reconnect them with VA services. However, such programs often encounter barriers getting implemented into routine care. Adaptive designs are needed when the implementation intervention requires augmentation within sites that do not initially respond to an initial implementation intervention. This protocol describes the methods used in an adaptive implementation design study that aims to compare the effectiveness of a standard implementation strategy (Replicating Effective Programs, or REP) with REP enhanced with External Facilitation (enhanced REP) to promote the uptake of Re-Engage.Methods/design: This study employs a four-phase, two-arm, longitudinal, clustered randomized trial design. VA sites (n = 158) across the United States with a designated Re-Engage provider, at least one Veteran with SMI lost to care, and who received standard REP during a six-month run-in phase. Subsequently, 88 sites with inadequate uptake were stratified at the cluster level by geographic region (n = 4) and VA regional service network (n = 20) and randomized to REP (n = 49) vs. enhanced REP (n = 39) in phase two. The primary outcome was the percentage of veterans on each facility outreach list documented on an electronic web registry. The intervention was at the site and network level and consisted of standard REP versus REP enhanced by external phone facilitation consults. At 12 months, enhanced REP sites returned to standard REP and 36 sites with inadequate participation received enhanced REP for six months in phase three. Secondary implementation outcomes included the percentage of veterans contacted directly by site providers and the percentage re-engaged in VA health services.
Adaptive implementation designs consisting of a sequence of decision rules that are tailored based on a site's uptake of an effective program may produce more relevant, rapid, and generalizable results by more quickly validating or rejecting new implementation strategies, thus enhancing the efficiency and sustainability of implementation research and potentially leading to the rollout of more cost-efficient implementation strategies.Trial registration: Current Controlled Trials ISRCTN21059161.
Full-text · Article · Nov 2013 · Implementation Science
[Show abstract][Hide abstract]ABSTRACT: This study examined whether Medicaid claims and other administrative data could identify high-need individuals with serious mental illness in need of outreach in a large urban setting. A claims-based notification algorithm identified individuals belonging to high-need cohorts who may not be receiving needed services. Reviewers contacted providers who previously served the individuals to confirm whether they were in need of outreach. Over 10,000 individuals set a notification flag over 12-months. Disengagement was confirmed in 55 % of completed reviews, but outreach was initiated for only 30 %. Disengagement and outreach status varied by high-need cohort.
No preview · Article · May 2013 · Administration and Policy in Mental Health and Mental Health Services Research