Comparative Effectiveness, 2010
Connecticut Department of Social Services
As a result of participating in the Medicaid Medical Directors' Learning Network—an AHRQ Knowledge Transfer project—Connecticut Medicaid officials used two AHRQ research reports to make policy and program decisions. The products influencing their decisions were the Comparative Effectiveness Review, Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics, and the Evidence Report/Technology Assessment, Cesarean Delivery on Maternal Request.
The AHRQ Effective Health Care Program review about off-label use of atypical antipsychotics was consulted during development of legislation for the Connecticut governor's 2009-2011 budget. That legislation adds behavioral health medications, such as atypical antipsychotic drugs, to Medicaid's preferred drug list and also provides for the monitoring of the drugs' use, particularly in children.
Robert Zavoski, MD, MPH, Medicaid Medical Director, Connecticut Department of Social Services, reports that in the past, behavioral medications were exempt from review by the Medicaid program. However, he states, "The AHRQ information, in combination with our State data, demonstrated the clear need—not just from a financial point of view, but also from a clinical point of view—to enhance the review of these medications and monitor their use far more closely than we have been."
Atypical antipsychotic medications are second-generation drugs designed to cause fewer neurological complications than conventional antipsychotics. Some atypical antipsychotics approved to treat schizophrenia and bipolar disorders are prescribed off-label for conditions in young children with behavior problems such as attention-deficit disorder and aggression.
In addition, Connecticut's Medicaid managed care programs have implemented a performance improvement project that includes a number of performance measures in women's health care. The AHRQ Evidence Report, Cesarean Delivery on Maternal Request, notes the rising rate of cesarean deliveries in the United States and suggests that the incidence of those performed upon maternal request also is rising. According to Zavoski, the AHRQ report was a beneficial resource to State policymakers as they encouraged the adoption of measures that captured both the rates of cesarean deliveries and how those surgeries are scheduled.
Zavoski says, "The AHRQ Evidence Reports provide me with the latest research in areas where I have little previous clinical experience. Additionally, as the State faces incredible financial hardships, it helps to be able to say that not only does a decision make financial sense, but it also makes clinical sense."
Knowledge Transfer Case Study Identifier: KT-COE-43
AHRQ Product: Medicaid Medical Directors' Learning Network, Effective Health Care Program
Topic(s): Women's Health, Pediatrics, Mental Health, Prescription Medications
Cesarean Delivery on Maternal Request, March 2006. Evidence Report/Technology Assessment No. 133. AHRQ Publication No. 06-E009. Agency for Healthcare Research and Quality, Rockville, MD.
Efficacy and Comparative Effectiveness of Off-Label Use of Atypical Antipsychotics, January 2007. Comparative Effectiveness Review No. 6. Agency for Healthcare Research and Quality, Rockville, MD.
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