Use of Pooled State Administrative Data for Mental

Authors: Kimberly Eaton Hoagwood Susan Essock Joseph Morrissey Anne Libby Sheila Donahue Benjamin Druss Molly Finnerty Linda Frisman Meera Narasimhan Bradley D Stein Jennifer Wisdom Judy Zerzan

Publish Date: 2015/01/13

Volume: 43, Issue: 1, Pages: 67-78

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Abstract

State systems are a rich albeit challenging laboratory for policyrelevant services research studies State mental health authorities routinely devote resources to collect data for state planning and reporting purposes However these data are rarely used in crossstate comparisons to inform state or federal policy development In 2008 in response to key recommendations from the National Institute of Mental Health NIMH Advisory Council’s “The Road Ahead Research Partnership to Transform Services” http//wwwnimhnihgov/about/advisoryboardsandgroups/namhc/reports/roadaheadpdf NIMH issued a request for applications RFA to support studies on the impact of state policy changes on access cost quality and outcomes of care for individuals with mental disorders The purpose of the RFA was to bridge the divide between research and policy by encouraging research that used state administrative data across states and to address significant statedefined health policy initiatives Five projects involving eight states were selected through peer review for funding Projects began in 2009 and were funded for 3 years This report provides a brief description of the five projects followed by an analysis of the impact challenges and lessons learned from these policypartnered studies We conclude by offering suggestions on ways to use state administrative data for informing state health policies which is especially timely given national and state changes in the structure and financing of healthcareState mental health systems routinely collect data for state planning and reporting purposes All states collect Medicaid data and utilization data for reimbursement that can be used for quality improvement States are required to report data for special populations served Many states collect additional data through other systems such as child welfare corrections aging housing and education programs In addition there are administrative data collected through federal agencies eg Centers for Medicare Medicaid Services CMS Social Security Administration SSA Substance Abuse and Mental Health Services Administration SAMHSA Centers for Disease Control and Prevention CDC and Department of Justice DOJ that are available for analyses Given the vast amount of data and the cumbersomeness of combining data across these entities such data may be underutilized in the development and monitoring of mental health policiesThis is unfortunate because state systems are a fertile if challenging laboratory for policyrelevant services research studies Such studies can test the impact of policy decisions on health services delivery Using these data to not only inform but to create a set of evidencebased policies has immediate almost intuitive appeal to policymakers and healthcare decisionmakers Goldman et al 2001In the development of public policies about healthcare services however research evidence can be secondary to interests such as advocacy political initiatives media stereotypes and public opinion Bowen and Zwi 2005 Dobrow et al 2004 Waddell et al 2005 Competing interests are often overlooked in studies examining the use of research evidence by policymakers Lomas and Brown 2009 Furthermore the question of what kind of evidence or information policymakers actually draw upon when making decisions has been largely unaddressed by researchers Hyde et al in press Soydan and Palinkas 2014State mental health systems face an increasingly uncertain environment in which to develop healthcare policies as the pressures to regulate and manage mental health services are constrained by tighter budgets changing federal rules smaller allocation of funds through block grants and ambiguities about the implementation of the Patient Protection and Affordability Care Act ACA passed in 2010 Hoagwood et al 2014 State responses to these changes are highlighting the importance of using data systematically to drive healthcare service delivery and decisionmaking Gray 2013 Kazdin 2013 Kazdin and Rabbitt 2013 Kelleher 2010 For example states are struggling with ways to integrate data across their systems and to identify quality indicators for use in monitoring processes and outcomes of care as part of quality improvement initiatives Institute of Medicine Committee on Quality of Health Care in America 2006 Institute of Medicine Committee on Science Engineering and Public Policy National Academy of Sciences National Academy of Engineering 2009 Institute of Medicine Committee on Quality of Health Care in America 2000In 2008 in response to key recommendations from the NIMH Advisory Council’s “The Road Ahead Research Partnership to Transform Services” http//wwwnimhnihgov/about/advisoryboardsandgroups/namhc/reports/roadaheadpdf NIMH issued an RFA RFAMH09050 to support studies on the impact of state policy changes on access cost quality and outcomes of care for individuals with mental disorders The purpose of the RFA was to bridge the gap between research and policy The RFA required applicants to build their proposed studies around four design considerations that differentiated these studies from typical academic research First applicants were required to apply jointly with one principal investigator representing a state policy perspective and the other principal investigator a universitybased researcher Second two states had to be included for comparison purposes Third applicants were required to use existing administrative data no new data collection was authorized so as to reduce costs model the use of existing administrative data and in principle produce more timely findings Fourth each project had to identify study aims that addressed significant mental health policy questions of interest to the host state mental health authority not just to the researchers with a research plan that was methodologically rigorous and able to meet peerreview standardsFive projects were selected for funding through peer review In this report the grantees provide a brief description of the five projects including goals methods and their policy or program impacts In addition we share the challenges and lessons learned across studies We conclude by offering suggestions about ways to use state administrative data to inform the kinds of healthcare policy assessments envisioned by the Patient Protection and Affordability Care Act ACA Some of the projects’ findings already have undergone peer review and in those cases we cite the relevant publications Other findings are summarized here prior to submission for peer review hence must be interpreted with appropriate caution

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