Issues Exploration Forum (IEF): Serious Mental Illness (Text Version)

On September 27, 2010, Daniel Jonas made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (650 KB).  

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Slide 1

Issues Exploration Forum (IEF): Serious Mental Illness

Dan Jonas, MD, MPH

Slide 2

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 and uncertainty in clinical practice and outcomes.
  • Reducing methodological and conceptual uncertainty.
  • Reducing disease burden.

Slide 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).

Slide 4

Framework for CER

Image: A flowchart of the Framework for CER is shown. On the far left are two ovals labeled "Horizon Scanning" and "Evidence Synthesis" double-headed arrows point both to and from these ovals to another oval labeled "Evidence Needs Identification." An arrow points from this oval to a box labeled "Evidence Generation, Interventions, Conditions, Populations." An arrow also points from "Evidence Synthesis" to this same box. An arrow points from this box to a smaller box labeled "Dissemination Translation," and an arrow points from this smaller box to the box on the far right of the flowchart, which is labeled "Improvements in Health Care." An arrow points from "Improvements in Health Care" across the top of the flowchart back to "Horizon Scanning." A text box at the bottom of the chart is labeled "Research Platform: Infrastructure - Methods Development - Training."

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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.

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Adults with SMI and Mood or Psychotic Disorders

SMI 12-month prevalence = 8.3%
Mood Disorders 12-month prevalence = 9.7%
Psychotic Disorders including Schizophrenia lifetime prevalence = 1.5%

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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:
  1. Conceptual Framework for Research.
  2. Patient-centered Care: Improving outcomes that matter to patients.
  3. Reducing Disparities.

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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

Slide 9

More information

• Upcoming publication.
• AHRQ Web site once completed.
• Topic nomination.

Slide 10

Additional Information

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Prioritized Themes

1. Measurement and outcomes need consensus definitions.
2. Development of infrastructure for research: longitudinal studies, new investigators, and datasets.
3. Service delivery, treatment settings, and structuring the delivery of care.
4. Development of CER methodology.
5. Identify disparities and reasons for disparities and reevaluate the framework for researching disparities.
6. Role of the therapeutic relationship.
7. Strategies to personalize/individualize treatment.

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Prioritized Themes

8. Treatment approaches to avoid early mortality and morbidity.
9. Role of the psychiatric hospital, lengths of stay, and transition support services after discharge.
10. Retooling universities and education.
11. Strategies to increase adherence to evidence-based guidelines and treatment regimens.
12. Correctional programs and interventions for people involved with the criminal justice system.
13. Interventions for people with comorbid medical illness or substance abuse.
14. Prevention, early identification, trajectories, and developmental perspective.

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Prioritized Themes

15. Dissemination and implementation.
16. Reducing barriers and improving access.
17. Mental health policy.
18. Modifiable factors: tobacco, exercise, and nutrition.
19. Alternatives to force or involuntary approaches.
20. Providing housing or social support.
21. Strategies to reduce stigma, prejudice, and discrimination.

Slide 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, 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.

* Some individuals represent more than one entity or area of expertise.