Alexander S Young1,2, Evelyn T Chang3,4, Amy N Cohen5, Rebecca Oberman3, Dennis T Chang6, Alison B Hamilton3,4, Laurie A Lindamer7, Jesse Sanford4, Fiona Whelan4. 1. Greater Los Angeles Veterans Healthcare System, Los Angeles, CA, USA. ayoung@ucla.edu. 2. University of California, Los Angeles, CA, USA. ayoung@ucla.edu. 3. Greater Los Angeles Veterans Healthcare System, Los Angeles, CA, USA. 4. University of California, Los Angeles, CA, USA. 5. American Psychiatric Association, Washington, DC, USA. 6. Southern Nevada Veterans Healthcare System, North Las Vegas, NV, USA. 7. San Diego Veterans Healthcare System, San Diego, CA, USA.
Abstract
BACKGROUND: There are unmet primary care needs among people with serious mental illness that might be improved with integrated care and medical care management. Many healthcare organizations have attempted to address this problem, but few interventions have been rigorously studied and found to be effective. OBJECTIVE: Study the implementation and effectiveness of a novel, specialized primary care medical home designed to improve the healthcare of patients with serious mental illness. DESIGN, SETTING, AND PARTICIPANTS: Clustered controlled trial for a median of 401 days. One Veterans Health Administration medical center was assigned to intervention and two were assigned to usual care (control). Thirty-nine clinicians and managers were included in the study, as well as 331 patients who met eligibility criteria. INTERVENTION: A specialized medical home with systematic patient engagement, proactive nurse panel management, a collaborative care psychiatrist, and a primary care physician providing care that included psychiatric treatment. MAIN MEASURES: Quality of care, chronic illness care and care experience, symptoms, and quality of life. KEY RESULTS: Sixty-five intervention patients (40%) moved all psychiatric care to the primary care team. No adverse events were attributable to the intervention. Compared with control, intervention patients had greater improvement over time in appropriate screening for body mass index, lipids, and glucose (χ2 = 6.9, 14.3, and 3.9; P's < .05); greater improvement in all domains of chronic illness care (activation, decision support, goal-setting, counseling, coordination) and care experience (doctor-patient interaction, shared decision-making, care coordination, access; F for each 10-24, P's < .05); and greater improvement in mental health-related quality of life (F = 3.9, P = .05) and psychotic symptoms (F = 3.9, P = .05). CONCLUSION: A primary care medical home for serious mental illness can be feasible to implement, safe, and more effective than usual care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01668355.
BACKGROUND: There are unmet primary care needs among people with serious mental illness that might be improved with integrated care and medical care management. Many healthcare organizations have attempted to address this problem, but few interventions have been rigorously studied and found to be effective. OBJECTIVE: Study the implementation and effectiveness of a novel, specialized primary care medical home designed to improve the healthcare of patients with serious mental illness. DESIGN, SETTING, AND PARTICIPANTS: Clustered controlled trial for a median of 401 days. One Veterans Health Administration medical center was assigned to intervention and two were assigned to usual care (control). Thirty-nine clinicians and managers were included in the study, as well as 331 patients who met eligibility criteria. INTERVENTION: A specialized medical home with systematic patient engagement, proactive nurse panel management, a collaborative care psychiatrist, and a primary care physician providing care that included psychiatric treatment. MAIN MEASURES: Quality of care, chronic illness care and care experience, symptoms, and quality of life. KEY RESULTS: Sixty-five intervention patients (40%) moved all psychiatric care to the primary care team. No adverse events were attributable to the intervention. Compared with control, intervention patients had greater improvement over time in appropriate screening for body mass index, lipids, and glucose (χ2 = 6.9, 14.3, and 3.9; P's < .05); greater improvement in all domains of chronic illness care (activation, decision support, goal-setting, counseling, coordination) and care experience (doctor-patient interaction, shared decision-making, care coordination, access; F for each 10-24, P's < .05); and greater improvement in mental health-related quality of life (F = 3.9, P = .05) and psychotic symptoms (F = 3.9, P = .05). CONCLUSION: A primary care medical home for serious mental illness can be feasible to implement, safe, and more effective than usual care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01668355.
Keywords:
Behavioral health; Care coordination; Disparities; Health system, hospital or practice redesign; Patient centered medial home; Screening; Veteran care
Authors: Daniel W Bradford; Natasha T Cunningham; Monica N Slubicki; Jennifer R McDuffie; Amy M Kilbourne; Avishek Nagi; John W Williams Journal: J Clin Psychiatry Date: 2013-08 Impact factor: 4.384
Authors: Mark S Bauer; Linda McBride; William O Williford; Henry Glick; Bruce Kinosian; Lori Altshuler; Thomas Beresford; Amy M Kilbourne; Martha Sajatovic Journal: Psychiatr Serv Date: 2006-07 Impact factor: 3.084
Authors: Jesse C Lichstein; Marisa E Domino; Christopher A Beadles; Alan R Ellis; Joel F Farley; Joseph P Morrissey; Gordon W Gauchat; C Annette Dubard; Carlos T Jackson Journal: Med Care Date: 2014-03 Impact factor: 2.983
Authors: Li Wang; Brian Porter; Charles Maynard; Ginger Evans; Christopher Bryson; Haili Sun; Indra Gupta; Elliott Lowy; Mary McDonell; Kathleen Frisbee; Christopher Nielson; Fred Kirkland; Stephan D Fihn Journal: Med Care Date: 2013-04 Impact factor: 2.983
Authors: Lexie R Grove; Alex K Gertner; Karen E Swietek; Ching-Ching Claire Lin; Neepa Ray; Tyler L Malone; David L Rosen; Theodore R Zarzar; Marisa Elena Domino; Brian Sheitman; Beat D Steiner Journal: J Gen Intern Med Date: 2021-01-27 Impact factor: 5.128
Authors: Justin K Benzer; Sarah Beehler; Christopher Miller; James F Burgess; Jennifer L Sullivan; David C Mohr; Mark Meterko; Irene E Cramer Journal: Depress Res Treat Date: 2012-07-29