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美国必须改善其数据基础设施,以确保高质量的精神卫生保健。

The United States must improve its data infrastructure to ensure high-quality mental health care.

作者信息

Mark Tami L

机构信息

RTI International, Durham, NC, United States.

出版信息

Front Health Serv. 2023 Feb 28;3:1059049. doi: 10.3389/frhs.2023.1059049. eCollection 2023.

Abstract

Use of and spending on mental health services in the United States more than doubled over the past two decades. In 2019, 19.2% of adults received mental health treatment (medications and/or counseling) at a cost of $135 billion. Yet, the United States has no data collection system to determine what proportion of the population benefited from treatment. Experts have for decades called for a learning behavioral health care system: a system that collects data on treatment services and outcomes to generate knowledge to improve practice. As the rates of suicide, depression, and drug overdoses in the United States continue to rise, the need for a learning health care system becomes even more pressing. In this paper, I suggest steps to move toward such a system. First, I describe the availability of data on mental health service use, mortality, symptoms, functioning, and quality of life. In the United States, the best sources of longitudinal information on mental health services received are Medicare, Medicaid, and private insurance claims and enrollment data. Federal and state agencies are starting to link these data to mortality information; however, these efforts need to be substantially expanded and include information on mental health symptoms, functioning, and quality of life. Finally, there must be greater efforts to make the data easier to access such as through standard data use agreements, online analytic tools, and data portals. Federal and state mental health policy leaders should be at the forefront of efforts to create a learning mental health care system.

摘要

在过去二十年中,美国心理健康服务的使用和支出增加了一倍多。2019年,19.2%的成年人接受了心理健康治疗(药物治疗和/或咨询),费用为1350亿美元。然而,美国没有数据收集系统来确定受益于治疗的人口比例。几十年来,专家们一直呼吁建立一个学习型行为医疗保健系统:一个收集治疗服务和结果数据以生成知识来改进实践的系统。随着美国自杀、抑郁和药物过量率持续上升,建立学习型医疗保健系统的需求变得更加迫切。在本文中,我提出了迈向这样一个系统的步骤。首先,我描述了心理健康服务使用、死亡率、症状、功能和生活质量方面的数据可用性。在美国,关于接受心理健康服务的纵向信息的最佳来源是医疗保险、医疗补助以及私人保险理赔和参保数据。联邦和州机构开始将这些数据与死亡率信息相链接;然而,这些努力需要大幅扩展,并纳入心理健康症状、功能和生活质量方面的信息。最后,必须做出更大努力,使数据更易于获取,比如通过标准数据使用协议、在线分析工具和数据门户。联邦和州心理健康政策领导人应站在创建学习型心理健康护理系统努力的前沿。

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