Use of Administrative Data to Identify Potential Service Gaps for Individuals With Serious Mental Illness

New York City Department of Health and Mental Hygiene, לאנג איילענד סיטי, New York, United States
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 09/2011; 62(9):1094-7. DOI: 10.1176/
Source: PubMed


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. "
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    • "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]. "
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