title: Use of administrative data to identify potential service gaps for individuals with serious mental illness.
abstract: OBJECTIVE
  The New York City Mental Health Care Monitoring Initiative uses Medicaid claims data to identify individuals with serious mental illness who are experiencing or at risk for gaps in services. In this study the authors assessed whether proposed service use algorithms accurately identified such individuals.
  
  
  METHODS
  A random sample of 500 individuals with serious mental illness was identified. Individuals belonged to specific high-need cohorts and met predefined claims-based criteria for potential service gaps. Clinical staff initiated reviews with prior service providers for 230 individuals.
  
  
  RESULTS
  Over a two-week period staff completed reviews for 188 cases (88%). In 66 cases (35%) the individual was fully engaged in care; 84 (45%) had a recent episode of disengagement that was appropriately addressed, and 38 (20%) were not receiving adequate services.
  
  
  CONCLUSIONS
  The proposed service use algorithms successfully identified high-need individuals with serious mental illness at risk for gaps in services.
authors: Department of Psychiatry, Columbia University, New York City, and the New York State Psychiatric Institute, 1051 Riverside Dr, Unit 100, New York, NY 10032, USA. tes2001@columbia.edu
authors: Thomas E
authors: TE
authors: Smith
authors: Anita
authors: A
authors: Appel
authors: Sheila A
authors: SA
authors: Donahue
authors: Susan M
authors: SM
authors: Essock
authors: Carlos T
authors: CT
authors: Jackson
authors: Adam
authors: A
authors: Karpati
authors: Trish
authors: T
authors: Marsik
authors: Robert W
authors: RW
authors: Myers
authors: Lily
authors: L
authors: Tom
mesh_terms: D006801:Humans; D008330:Management Audit / Q000379:methods*; D001523:Mental Disorders; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards*; D009519:New York City; D012720:Severity of Illness Index