Evaluation of the Santa Clara County Mental Health Service Pay for Performance Quality Improvement Initiative
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 652
- 主要终点
- Total cost of 24-hour psychiatric services (12 months)
研究概览
简要总结
Healthcare systems in the United States (U.S.) have long faced the considerable challenge of managing budgetary pressures while at the same time helping people with serious mental illness and/or addiction. One potential way to address this challenge is to offer community-based services for individuals who are high-utilizers of expensive emergency and inpatient psychiatric services. Due to the decentralized nature of California governance, responsibility for mental health services falls primarily to the individual counties. The County of Santa Clara, CA invests significantly in community-based services as well as 24-hour care settings. This County adopted an innovative Pay for Performance (PFP) model and contracted with a new care provider to better meet the needs of this patient population and, in turn, reduce demand on the County's 24-hour psychiatric services. Whether this innovative contracting framework will help individuals who thus far have not responded well to mental health services is unknown. The purpose of this study was to determine whether the quality of care for these high-need patients was improved and at a sustainable cost. To this end, a randomized clinical trial (RCT) was conducted to determine whether this innovative quality improvement initiative, referred to as "Partners in Wellness", was successful at reducing the total cost of 24-hour psychiatric care used by enrollees compared to individuals who concurrently received services from the county. Individuals were randomly assigned to the Usual Care (UC) or Pay-For-Performance (PFP) conditions. The primary outcome of this evaluation was reduction in the total cost of 24-hour psychiatric services in the target population.
the primary outcome of this evaluation was reduction in the total cost of 24-hour psychiatric services in the target population.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 65 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Individuals with a history of extensive utilization of 24-hour psychiatric services in Santa Clara County, CA and a likelihood of continuing to use them in the future.
排除标准
- •Age 17 or younger
- •Born before 1952
- •Not current resident of the County
- •Currently residing in a state hospital
- •Registered sex offender with legally imposed residency restrictions
- •Have a DSM-V diagnosis of (or meet diagnostic criteria for):
- •Autism Spectrum Disorder
- •Catatonia
- •Brief Psychotic Disorder
- •Traumatic head injury resulting in severe cognitive impairment
- •IQ of 69 or lower
- •Eating disorders, including Pica, Anorexia Nervosa and Bulimia Nervosa, or
- •Pyromania, or Psychogenic Polydipsia paired with life threatening behaviors in the past 12 months.
- •Serious risk to self (i.e., suicidal intent with specific plan OR command hallucinations for self-harm that were acted on in the last 30 days and resulted in significant physical injury, or without staff intervention would have resulted in significant physical injury.
- •Risk to others (e.g., sexual aggression or other violent, assaultive behavior toward clinical staff in the past 12 months).
- •Serious medical diagnoses that either require intensive and regular home health care (e.g., Cystic Fibrosis, Parkinson's, Cancer), imminent risk of placement in a Skilled Nursing Facility or nursing home (e.g., non-ambulatory; needing would care), or are terminal or are life-threatening.
- •Significant functional impairments (e.g., unable to toilet, incontinent and refuse to wear diaper, refuse to eat or drink, refuse to dress self or wear clothes, unable to transfer in/out of bed)
结局指标
主要结局
Total cost of 24-hour psychiatric services (12 months)
时间窗: 12 months post-enrollment
Total cost of the following care types beginning from enrollment until 12 months post-enrollment: Emergency Psychiatric Services (EPS), Barbara Arons Pavilion (BAP) Acute Psychiatric Inpatient, Contract Hospital, Institutes of Mental Disease (IMD), State Hospital, Crisis Residential, Transitional Residential, Super Board and Care, and Residential Care Facility. Days of utilization for each service were multiplied by estimates of the average costs per client, per day provided by the County. To create the primary outcome measure, costs from all of these sources were summed.
Total cost of 24-hour psychiatric services (24 months)
时间窗: 24 months post-enrollment
Total cost of the following care types beginning from enrollment until 24 months post-enrollment: Emergency Psychiatric Services (EPS), Barbara Arons Pavilion (BAP) Acute Psychiatric Inpatient, Contract Hospital, Institutes of Mental Disease (IMD), State Hospital, Crisis Residential, Transitional Residential, Super Board and Care, and Residential Care Facility. Days of utilization for each service were multiplied by estimates of the average costs per client, per day provided by the County. To create the primary outcome measure, costs from all of these sources were summed.
Total cost of 24-hour psychiatric services (36 months)
时间窗: 36 months post-enrollment
Total cost of the following care types beginning from enrollment until 36 months post-enrollment: Emergency Psychiatric Services (EPS), Barbara Arons Pavilion (BAP) Acute Psychiatric Inpatient, Contract Hospital, Institutes of Mental Disease (IMD), State Hospital, Crisis Residential, Transitional Residential, Super Board and Care, and Residential Care Facility. Days of utilization for each service were multiplied by estimates of the average costs per client, per day provided by the County. To create the primary outcome measure, costs from all of these sources were summed.
次要结局
- Total cost of Barbara Arons Pavilion (BAP) Acute Inpatient Psychiatric Care (12 months)(12 months post-enrollment)
- Total cost of Contract Hospital (24 months)(24 months post-enrollment)
- Total cost of Transitional Residential (12 months)(12 months post-enrollment)
- Total cost of Residential Care Facility (36 months)(36 months post-enrollment)
- Total cost of Custody Health (36 months)(36 months post-enrollment)
- Total cost of Crisis Residential Facility (36 months)(36 months post-enrollment)
- Total cost of Transitional Residential (24 months)(24 months post-enrollment)
- Total cost of Residential Care Facility (24 months)(24 months post-enrollment)
- Total cost of Custody Health (12 months)(12 months post-enrollment)
- Total cost of Barbara Arons Pavilion (BAP) Acute Inpatient Psychiatric Care (24 months)(24 months post-enrollment)
- Total cost of Barbara Arons Pavilion (BAP) Acute Inpatient Psychiatric Care (36 months)(36 months post-enrollment)
- Total cost of Emergency Psychiatric Services (EPS) - 12 months(12 months post-enrollment)
- Total cost of Contract Hospital (36 months)(36 months post-enrollment)
- Total cost of Crisis Residential Facility (12 months)(12 months post-enrollment)
- Total cost of Emergency Psychiatric Services (EPS) - 24 months(24 months post-enrollment)
- Total cost of Emergency Psychiatric Services (EPS) - 36 months(36 months post-enrollment)
- Total cost of Contract Hospital (12 months)(12 months post-enrollment)
- Total cost of Crisis Residential Facility (24 months)(24 months post-enrollment)
- Total cost of Transitional Residential (36 months)(36 months post-enrollment)
- Total cost of Residential Care Facility (12 months)(12 months post-enrollment)
- Total cost of Institutes of Mental Disease (12 months)(12 months post-enrollment)
- Total cost of Institutes of Mental Disease (36 months)(36 months post-enrollment)
- Incarceration (24 months)(24 months post-enrollment)
- Total cost of Institutes of Mental Disease (24 months)(24 months post-enrollment)
- Total cost of Custody Health (24 months)(24 months post-enrollment)
- Incarceration (12 months)(12 months post-enrollment)
- Incarceration (36 months)(36 months post-enrollment)
研究者
Keith Humphreys
Professor
Stanford University