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

> **NIH AHRQ R01** · RUTGERS, THE STATE UNIV OF N.J. · 2020 · $384,978

## Abstract

This project will address, at scale, improvement of safe use practices for antipsychotic (AP) treatment of
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. Safety evidence and guidelines highlight the importance of several key safe-use
practices that can help mitigate these risks, including monitoring blood glucose and lipids; avoiding concurrent
use of multiple different APs; first-line use of non-pharmacological mental health services; and minimizing use
among pre-school children. Prior AHRQ-supported projects have led to HEDIS/CMS quality metrics for these
practices, but their implementation is highly inconsistent. Many state initiatives have been implemented to
improve these safe-use practices, but the impact of alternative strategies for increasing safe-use is unknown.
Evidence on their effects is critically needed. We will use a mixed-methods strategy to identify and document
state implementation of safe-use initiatives; assess their impact on safe use metrics; investigate causal
mechanisms underlying effectiveness; and actively disseminate results to state decisionmakers, health plans,
clinical communities, and other stakeholders. This process will support translation, implementation, and
improvement of effective strategies across states. We will provide a comprehensive analysis of systems-level
strategies, using a national survey and case studies in 8 purposively sampled states, to investigate distinctive
approaches. We will use key informant interviews and systematic document review to identify implementation
timelines, strategies, causal mechanisms, 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. States
that did not implement similar initiatives will serve as comparators. Finally, we will actively disseminate an
evidence-informed toolkit to state and stakeholder communities, utilizing active dissemination strategies
successfully employed in prior AHRQ-supported partnerships. This toolkit will be developed to facilitate a self-
assessment and prioritization of improvement initiatives, identification of other state strategies, and provide
quality improvement and evaluation tools to assess effectiveness over time. 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 populations of vulnerable children served by state
Medicaid/CHIP systems and reduce AP-related harms.

## Key facts

- **NIH application ID:** 9980917
- **Project number:** 5R01HS026001-03
- **Recipient organization:** RUTGERS, THE STATE UNIV OF N.J.
- **Principal Investigator:** Stephen Crystal
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $384,978
- **Award type:** 5
- **Project period:** 2018-09-30 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9980917

## Citation

> US National Institutes of Health, RePORTER application 9980917, Advancing Patient Safety for Antipsychotic-Treated Children: Examining State Implementation of Safe Use Practices (5R01HS026001-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9980917. Licensed CC0.

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