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 Ralph Gonzales -

Excellent!  You seem to have identified an area that would be ripe for more effective interventions.  You might look to find parallel conditions, like HIV, where people are also working on designing interventions to address metabolic comorbidity prevention.

1. Readiness for translation.  Nice.  Might mention what “level” of evidence is used by these associations… are they based on RCT, observational data or just “expert opinion”?

2. Key behavior.  Nice job being specific about your target audience.  Might also mention what the “metabolic screening” entails, and how often they should do it.

3.  Gap Analysis.  Nice.  Do you have a “source” for the 30% rate? 

B.  Quality Gap:  Good. 

C. Outcome Gap:  Wow.  That’s significant.  Would be good to show the actual rates of heart disease and cardiovascular mortality for this group vs. general population.

D.  This is true.  Is there any evidence in your target population?

Re: Mangurian Protocol Assignment #1

by Matt Hickey -

Thanks Christina, this is really interesting.

It sounds like the behavior that you are targeting is actual ordering of the screening test by providers.  This certainly seems like the most logical place to intervene.  I'm wondering though if there are any studies describing the reasons for non-screening.  I would assume that in many cases the screening tests are simply not ordered, but perhaps there are also other structural, economic, etc reasons as well) (e.g. lack of insurance, expensive co-payments).  Very interesting and looking forward to seeing how this progresses.