Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Infrastructure for research

• Infrastructure is needed that supports longitudinal studies including developing new investigators/investigator teams and providing additional training
• Facilitate infrastructure for comparable datasets (detailed registries) – consumers, care providers, interventions

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

• Compare different strategies for facilitating infrastructure (detailed registries and databases) including consumers, care providers, and interventions.
• Compare different approaches to develop infrastructure for longitudinal studies by developing new investigators and investigator teams and providing additional training.
• Compare the benefits of using various treatment settings as experiments for studies and treating service delivery systems as experiments.
• Compare the long-term effectiveness of psychotropic medications or other interventions for people with SMI. (One nominator suggested deleting this item due to lack of relevance.)
• Compare the effectiveness of research conduct and design strategies aiming to optimize long-term follow-up, while avoiding attrition bias and avoiding confounding the relationship between interventions and outcomes.
• Compare different approaches to analyzing long-term trial or observational data, such as using illness trajectories vs. typical measures (e.g., initial and follow-up measures of symptoms and level of functioning).

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Patients with Serious Mental Illness (SMI) (and specific mental illnesses)

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

• Longitudinal studies and improved infrastructure for research will inform best practices for care and management of SMI
• Creating a skilled workforce for CER mental health studies

Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Depression and other mental health disorders

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly
• Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Work is needed to facilitate infrastructure for comparable datasets (detailed registries), including consumers, care providers, and interventions.

There is considerable uncertainty regarding which treatments are best for which patients. The risks and benefits of using many common combinations of medications for people with SMI are uncertain. There are few studies investigating the effectiveness of combinations and sequencing of pharmacologic and nonpharmacologic treatments. Long-term studies reporting the most important outcomes (e.g., disability, functional ability, quality of life, and reduction of suicides) are lacking for people with SMI despite the chronic and disabling nature of these conditions.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Describe the timeframe in which an answer to your question is needed.

As soon as possible. This topic was prioritized during a series of stakeholder meetings focused on SMI, held July-August 2010.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

Through AHRQ and CTSA activities