利用行政数据识别严重精神疾病患者潜在的服务缺口。
Use of administrative data to identify potential service gaps for individuals with serious mental illness.
机构信息
Department of Psychiatry, Columbia University, New York City, and the New York State Psychiatric Institute, 1051 Riverside Dr, Unit 100, New York, NY 10032, USA.
出版信息
Psychiatr Serv. 2011 Sep;62(9):1094-7. doi: 10.1176/ps.62.9.pss6209_1094.
OBJECTIVE
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.
METHODS
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.
RESULTS
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.
CONCLUSIONS
The proposed service use algorithms successfully identified high-need individuals with serious mental illness at risk for gaps in services.
目的
纽约市精神保健监测倡议利用医疗补助数据来识别患有严重精神疾病且正在经历或面临服务中断风险的个人。在这项研究中，作者评估了拟议的服务使用算法是否能准确识别此类个人。
方法
随机抽取了 500 名患有严重精神疾病的个人。这些个人属于特定的高需求群体，并符合潜在服务差距的预定义基于索赔的标准。临床工作人员为 230 名个人的前服务提供者启动了审查。
结果
在两周的时间内，工作人员完成了 188 例（88%）的审查。在 66 例（35%）中，个人完全接受了治疗；84 例（45%）最近出现了适当解决的脱医情况，38 例（20%）未获得足够的服务。
结论
拟议的服务使用算法成功识别了患有严重精神疾病且面临服务中断风险的高需求个人。
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