Mangurian Protocol Assignment #1

Mangurian Protocol Assignment #1

by Christina Mangurian -
  1. A.     What evidence are you proposing to translate into practice?

I am proposing improving annual metabolic screening of people taking second-generation antipsychotic medications, who are being served in community mental health clinis.

  1. 1.     Justify that this evidence is “ready for translation.”

The evidence is ready for translation because there have been national guidelines recommended by the American Diabetes Association and the American Psychiatric Association (2004). 

 

  1. Identify a single, key behavior change target for your translational activity.

The behavioral target is metabolic screening by psychiatrists in community mental health clinics.  Basically, I want to increase the number of patients who obtain annual metabolic screening in community mental health clinics

 

  1. 3.     Conduct a “gap analysis” of your target behavior.  Look to diverse sources for “best guess” estimates if specific measures are not available.

10 years after the ADA/APA guidelines, metabolic screening rates are still only about 30%

 

B.  What is the quality (performance) gap?

Only 30% of people with severe mental illness receive metabolic screening by their physicians.  Therefore, there is a 70% gap in quality of care for this vulnerable population.  Ideally, I would like to eliminate this gap altogether.  Through my intervention, I aim to realistically reduce this gap for an additional 30% of the population, leaving a gap of 40%.

C.  What is the outcome gap?

People with severe mental illness taking these medications die 25 years earlier than the general population.  This mortality is most often from cardiovascular disease.

D.  Is there evidence that changing performance will improve health (clinical outcomes)? 

There is strong evidence that early detection and treatment of prediabetes, diabetes, hypertension, and dyslipidemia will reduce cardiovascular disease

Re: Mangurian Protocol Assignment #1

by Victoria Tang -

Great project idea, Christina! The important pieces are there and the only few comments I have are the following: 

For your protocol, I was wondering if it would help to include how many people are actually on these second generation anti-psychotics that are being followed in a mental health clinic to get an understanding of the impact the implementation of this project may have on a public health level.

How do you plan to change behavior in the community mental health clinics? Education? Policy? My limited understanding is that patients taking anti-psychotics are required to be monitored for side effects after so many months, I wonder if you can tack this on as management of a side effect of the medication, somehow. 

Vicky

Re: Mangurian Protocol Assignment #1

by Brian -

Christina- 

This is a great project and makes alot of sense. My comments/questions:

1. I would be curious how you envision the impact of increased diabetes screening on the clinic staff that administer/prescribe antipsychotics-- will they be responsible for treatment of diabetes and starting/managing medications or might it lead to a referral to specialty clinics/primary care clinics to start/initiate treatment. 

2. That those pts taking meds die 25 years earlier than general population is powerful message-- it may be useful in the proposal to note what % of patients are on anti-psychotics in these clinics.