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IEF Goals. Contribute to the establishment of an agenda to guide AHRQ's comparative effectiveness research (CER) activities in mental health and substance abuse (MHSA)Began March 2010 to identify focus areas within MHSA where conducting CER is most likely to have an impact on:Reducing variation an
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1. Issues Exploration Forum (IEF):.Serious Mental IllnessDan Jonas, MD, MPH
2. IEF Goals Contribute to the establishment of an agenda to guide AHRQs comparative effectiveness research (CER) activities in mental health and substance abuse (MHSA)
Began March 2010 to identify focus areas within MHSA where conducting CER is most likely to have an impact on:
Reducing variation and uncertainty in clinical practice and outcomes
Reducing methodological and conceptual uncertainty
Reducing disease burden
3. Objectives Engage a diverse group of stakeholders
Identify topics for future CER
Identify topics that are well-suited for evidence synthesis (i.e. systematic reviews, comparative effectiveness reviews)
4. Framework for CER
5. Focus of the Forum Decided upon Serious Mental Illness
High costs (direct and indirect)
Early morbidity
Early mortality
Availability of interventions to potentially reduce the burden of disease
6. Adults with SMI and Mood or Psychotic Disorders
7. Process Series of 3 meetings engaging approximately 40 stakeholders (7/15, 7/30, 8/19)
Initial generation of ideas and topics
Grouped input into 3 themes for the in-person meeting
Conceptual Framework for Research
Patient-centered Care: Improving outcomes that matter to patients
Reducing Disparities
8. Process
Additional topic generation and prioritization
Ultimately grouped similar ideas and topics under 21 prioritized themes
Identification of topics for evidence synthesis or evidence generation
9. More information Upcoming publication
AHRQ website once completed
Topic nomination
10. Additional Information
11. Prioritized Themes Measurement and outcomes need consensus definitions
Development of infrastructure for research: longitudinal studies, new investigators, and datasets
Service delivery, treatment settings, and structuring the delivery of care
Development of CER methodology
Identify disparities and reasons for disparities and reevaluate the framework for researching disparities
Role of the therapeutic relationship
Strategies to personalize/individualize treatment
12. Prioritized Themes Treatment approaches to avoid early mortality and morbidity
Role of the psychiatric hospital, lengths of stay, and transition support services after discharge
Retooling universities and education
Strategies to increase adherence to evidence-based guidelines and treatment regimens
Correctional programs and interventions for people involved with the criminal justice system
Interventions for people with comorbid medical illness or substance abuse
Prevention, early identification, trajectories, and developmental perspective
13. Prioritized Themes Dissemination and implementation
Reducing barriers and improving access
Mental health policy
Modifiable factors: tobacco, exercise, and nutrition
Alternatives to force or involuntary approaches
Providing housing or social support
Strategies to reduce stigma, prejudice, and discrimination
14. Stakeholders Total stakeholders participating = 39 total*
Including:
Federal representatives, researchers, clinicians, professional association representatives, individuals with expertise in racial/ethnic disparities, policymakers, payers, consumers, family members, advocates, representatives of the criminal justice system, and representatives of health systems.
Federal entities included: Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, http://www.Clinicaltrials.gov/, Food and Drug Administration, National Institute of Mental Health, Office of Disability, Aging, and Long-term Care Policy, Substance Abuse and Mental Health Services Administration, VA Capitol Health Care Network, and VA Desert Pacific.