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Stephen Crystal Receives AHRQ Grants

Stephen Crystal, principal investigator of “Applying Evidence to Improve Care and Outcomes in Severe Mental Illness” has been awarded four years of funding to continue the work of the established 6-state consortium for implementation of evidence-based practices in Medicaid mental health care. Three evidence-based practices will be implemented: 1) metabolic monitoring to improve early detection and guide ongoing management of abnormalities in glucose and lipid metabolism; 2) coordination of care transitions following hospital discharge to reduce the risk of early treatment disengagement and hospital readmission; and 3) appropriate use of uniquely effective and potentially lifesaving medications including clozapine, lithium, and long-acting injectable antipsychotic medications.

A set of metric-based, sustainable continuous quality improvement interventions will be implemented to increase uptake of evidence-based practices to improve patient outcomes. The consortium will engage state Medicaid and mental health leadership and other key stakeholders from Missouri, Wisconsin, Texas, California, Washington, and Oklahoma currently serving 193,000 adults with severe mental illnesses. The study builds on methods developed under the prior AHRQ-funded project that engaged these state Medicaid agencies in improving safe use of antipsychotic medications.

A five stage quality improvement process includes: 1) baseline quality profiles and problem analysis; 2) identification of intervention strategies, provision of evidence-based education and technical assistance; 3) development and implementation of state quality improvement plans and interventions; 4) deployment and incorporation of metrics into ongoing care processes and impact evaluation; and 5) local and national dissemination.

The project will increase uptake on a broad scale of a key set of measurable, modifiable, underutilized evidence-based practices that have significant potential for improvement in outcomes through a sustainable strategy that integrates measurement and education with policy tools available to state and managed care payers.

Stephen Crystal is also principal investigator of an AHRQ award, “Improving Medication Safety in Nursing Home Dementia Care” that will provide actionable knowledge to strengthen national and state initiatives to increase use of safer, person-centered dementia care practices especially in the use of antipsychotics (APs) among nursing home residents. Implementing alternative management strategies for the often-distressing behavioral and psychological manifestations of dementia is complex and often difficult. APs continue to be widely used in nursing homes despite strong evidence of increased mortality and a resulting FDA black box warning. It is essential to examine the comparative impact of varied state strategies for safer dementia management including co-occurring changes in other dimensions of dementia management and potential unintended consequences (such as substitution of sedative/hypnotics). There is a critical need for more specific and informative measurement of practices to more clearly define the underlying safety challenge; inform development of improved quality measures; and identify modifiable points of intervention. A stakeholder-engaged, multi-method study will integrate analysis of merged administrative data on the full national long-stay population with case-study and translational components.

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