Dataset Information

The Effectiveness of a Specialized Primary Care Medical Home for Patients with Serious Mental Illness.

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.

SUBMITTER: Young AS

PROVIDER: S-EPMC9550991 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Publications

The Effectiveness of a Specialized Primary Care Medical Home for Patients with Serious Mental Illness.

Young Alexander S AS Chang Evelyn T ET Cohen Amy N AN Oberman Rebecca R Chang Dennis T DT Hamilton Alison B AB Lindamer Laurie A LA Sanford Jesse J Whelan Fiona F

Journal of general internal medicine 20220405 13

<h4>Background</h4>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.<h4>Objective</h4>Study the implementation and effectiveness of a novel, specialized primary care medical home designed to improve the healthcare of patients with serious mental illness ...[more]

PMID: 35380346

Similar Datasets

Project description:BackgroundPeople with serious mental illness (SMI) die many years prematurely, with rates of premature mortality two to three times greater than the general population. Most premature deaths are due to "natural causes," especially cardiovascular disease and cancer. Often, people with SMI are not well engaged in primary care treatment and do not receive high-value preventative and medical services. There have been numerous efforts to improve this care, and few controlled trials, with inconsistent results. While people with SMI often do poorly with usual primary care arrangements, research suggests that integrated care and medical care management may improve treatment and outcomes, and reduce treatment costs.MethodsThis hybrid implementation-effectiveness study is a prospective, cluster controlled trial of a medical home, the SMI Patient-Aligned Care Team (SMI PACT), to improve the healthcare of patients with SMI enrolled with the Veterans Health Administration. The SMI PACT team includes proactive medical nurse care management, and integrated mental health treatment through regular psychiatry consultation and a collaborative care model. Patients are recruited to receive primary care through SMI PACT based on having a serious mental illness that is manageable with treatment, and elevated risk for hospitalization or death. In a site-level prospective controlled trial, this project studies the effect, relative to usual care, of SMI PACT on provision of appropriate preventive and medical treatments, health-related quality of life, satisfaction with care, and medical and mental health treatment utilization and costs. Research includes mixed-methods formative evaluation of usual care and SMI PACT implementation to strengthen the intervention and assess barriers and facilitators. Investigators examine relationships among organizational context, intervention factors, and patient and clinician outcomes, and identify patient factors related to successful patient outcomes.DiscussionThis will be one of the first controlled trials of the implementation and effectiveness of a patient centered medical home for people with serious mental illness. It will provide information regarding the value of this strategy, and processes and tools for implementing this model in community healthcare settings.Trial registrationClinicalTrials.gov, NCT01668355 . Registered August 20, 2012.

Dataset Information

The Effectiveness of a Specialized Primary Care Medical Home for Patients with Serious Mental Illness.

Background

Objective

Design, setting, and participants

Intervention

Main measures

Key results

Conclusion

Trial registration

Publications

The Effectiveness of a Specialized Primary Care Medical Home for Patients with Serious Mental Illness.

Similar Datasets

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