Advancing Patient Safety for Antipsychotic-Treated Children: Examining State Implementation of Safe Use Practices

  • Crystal, Stephen S. (PI)

Project Details


This project will address, at scale, improvement of safe medication use practices for antipsychotic (AP) treatment for Medicaid children. Safe and judicious management of APs poses significant challenges, given hazards that include elevated risk of Type 2 diabetes, weight gain, hyperglycemia, hyperlipidemia, and potential long-term impact on brain development, among others. Safety evidence and guidelines highlight the importance of several key safe-use practices that can help to mitigate these risks, including monitoring of blood glucose and lipids; avoiding concurrent use of multiple different APs; use of non-pharmacological mental health services as first-line treatment; and minimizing use among pre-school children. Prior AHRQ-supported projects have led to HEDIS/CMS quality metrics for these practices, but their use is highly inconsistent. Many state initiatives have been implemented aimed at this goal, but the impact of alternative strategies for increasing safe-use is unclear; evidence on these impacts is critically needed. We will use a mixed-methods strategy to identify and document state implementation of safe-use interventions; assess their impact on safe- use metrics; and actively disseminate results to state decisionmakers, health plans, clinical communities, and other stakeholders, to support the translation, implementation, and improvement of effective strategies across states. We will provide a comprehensive analysis of systems-level strategies to increase the safe-use practices using a national survey of Medicaid agencies and in-depth case studies of 8 of the programs. We will use key informant interviews and systematic document review to identify implementation timelines, strategies, barriers and solutions, and tools utilized. We will then use Medicaid claims data to assess change in the use of the targeted practices following the implementation of state systems-level strategies, using difference-in- difference, triple-difference and other modeling strategies, with within-state and cross-state comparators. Finally, we will actively disseminate findings to state and stakeholder communities, utilizing active dissemination strategies successfully employed in prior AHRQ-supported partnerships, supported by the development and dissemination of an evidence-informed toolkit to support the translation of effective practices across states and healthcare systems. This process of evidence development and active dissemination will assure that evidence on effective system-improvement processes is available, understood, and effectively used to improve patient safety across the large populations of vulnerable children served by state Medicaid/CHIP systems, to improve outcomes and reduce AP-related harms.
Effective start/end date9/30/187/31/23


  • Agency for Healthcare Research and Quality: $391,191.00


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