Advertisement

Psychiatric Quarterly

, Volume 89, Issue 4, pp 969–982 | Cite as

Community Mental Health Center Integrated Care Outcomes

  • Rebecca Wells
  • Bobbie Kite
  • Ellen Breckenridge
  • Tenaya Sunbury
Original Paper

Abstract

Despite the compelling logic for integrating care for people with serious mental illness, there is also need for quantitative evidence of results. This retrospective analysis used 2013–2015 data from seven community mental health centers to measure clinical processes and health outcomes for patients receiving integrated primary care (n = 18,505), as well as hospital use for the 3943 patients with hospitalizations during the study period. Bivariate and regression analyses tested associations between integrated care and preventive screening rates, hemoglobin A1c levels, and hospital use. Screening rates for body-mass index, blood pressure, smoking, and hemoglobin A1c all increased very substantially during integrated care. More than half of patients with baseline hypertension had this controlled within 90 days of beginning integrated care. Among patients hospitalized at any point during the study period, the probability of hospitalization in the first year of integrated care decreased by 18 percentage points, after controlling for other factors such as patient severity, insurance status, and demographics (p < .001). The average length of stay was also 32% shorter compared to the year prior to integrated care (p < .001). Savings due to reduced hospitalization frequency alone exceeded $1000 per patient. Data limitations restricted this study to a pre−/post-study design. However, the magnitude and consistency of findings across different outcomes suggest that for people with serious mental illness, integrated care can make a significant difference in rates of preventive care, health, and cost-related outcomes.

Keywords

Integration Community mental health center Primary care Preventive screening Hypertension Hospital use 

Notes

Funding

This study was funded by the Meadows Mental Health Policy Institute, the Texas Health and Human Services Commission, and the Centers for Medicare and Medicaid Services (#11-W-00278/6). The findings are those of the authors and do not necessarily represent the official position of the funders.

Compliance with Ethical Standards

Conflict of Interest

Rebecca Wells declares that she has no conflict of interest.

Bobbie Kite declares that she has no conflict of interest.

Ellen Breckenridge declares that she has no conflict of interest.

Tenaya Sunbury declares that she has no conflict of interest.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Because the data in this study derived from agency records, the principal investigator’s IRB waived informed consent as infeasible to obtain. Analyses were conducted only on de-identified data.

References

  1. 1.
    Gaynes B, Brown C, Lux LJ, Sheitman B, Ashok M, Boland E et al. Relationship between use of quality measures and improved outcomes in serious mental illness. Rockville, MD: Agency for Healthcare Research and Quality2015 Contract No.: AHRQ Publication No. 15-EHC003-EF.Google Scholar
  2. 2.
    Parks J, Svendsen D, Singer P, Foti ME, Mauer B. Morbidity and mortality in people with serious mental illness. Alexandria: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council; 2006.Google Scholar
  3. 3.
    Lutterman T, Ganju V, Schacht L, Shaw R, Monihan K, Huddle M. Sixteen state study on mental health performance measures. 2003.Google Scholar
  4. 4.
    Druss B, Zhao L, Von Esenwein S, Morrato E, Marcus S. Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Med Care. 2011;49(6):599–604.CrossRefGoogle Scholar
  5. 5.
    Pirraglia PA, Rowland E, Wu WC, Friedmann PD, O'Toole TP, Cohen LB, et al. Benefits of a primary care clinic co-located and integrated in a mental health setting for veterans with serious mental illness. Prev Chronic Dis. 2012;9:E51.PubMedPubMedCentralGoogle Scholar
  6. 6.
    MO Department of Mental Health, HealthNet. Progress report: Missouri CMHC healthcare homes: MO Department of Mental Health and MO HealthNet. 2013.Google Scholar
  7. 7.
    Kilbourne AM, Lai Z, Bowersox N, Pirraglia P, Bauer MS. Does colocated care improve access to cardiometabolic screening for patients with serious mental illness? Gen Hosp Psychiatry. 2011;33(6):634–6.CrossRefGoogle Scholar
  8. 8.
    Chwastiak L, Cruza-Guet M-C, Carroll-Scott A, Sernyak M, Ickovics J. Preventive counseling for chronic disease: missed opportunities in a community mental health center. Psychosomatics. 2013;54(4):328–35.CrossRefGoogle Scholar
  9. 9.
    Chwastiak L, Tsai J, Rosenheck R. Impact of health insurance status and a diagnosis of serious mental illness on whether chronically homeless individuals engage in primary care. Am J Public Health. 2012;102(12):e83–e9.CrossRefGoogle Scholar
  10. 10.
    Chang S-C, Lu M-L. Metabolic and cardiovascular adverse effects associated with treatment with antipsychotic drugs. J Exp Clin Med. 2012;4(2):103–7.CrossRefGoogle Scholar
  11. 11.
    Roberts L, Roalfe A, Wilson S, Lester H. Physical health care of patients with schizophrenia in primary care: a comparative study. Fam Pract. 2007;24(1):34–40.CrossRefGoogle Scholar
  12. 12.
    Planner C, Gask L, Reilly S. Serious mental illness and the role of primary care. Curr Psychiatry Rep. 2014;16(8):1–7.CrossRefGoogle Scholar
  13. 13.
    De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen DAN, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10(1):52–77.CrossRefGoogle Scholar
  14. 14.
    Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders—a systematic review and meta-analysis. Schizophr Bull. 2013;39(2):306–18.CrossRefGoogle Scholar
  15. 15.
    Bradford DW, Kim MM, Braxton LE, Marx CE, Butterfield M, Elbogen EB. Access to medical care among persons with psychotic and major affective disorders. Psychiatr Serv. 2008;59(8):847–52.CrossRefGoogle Scholar
  16. 16.
    Morrato EH, Newcomer JW, Kamat S, Baser O, Harnett J, Cuffel B. Metabolic screening after the American Diabetes Association's consensus statement on antipsychotic drugs and diabetes. Diabetes Care. 2009;32(6):1037–42.CrossRefGoogle Scholar
  17. 17.
    Collins C, Hewson DL, Munger R, Wade T. Evolving models of behavioral health integration in primary care. New York: Milbank Memorial Fund; 2010.CrossRefGoogle Scholar
  18. 18.
    Parks J, Pollack D, Bartels S, Mauer B. Integrating behavioral health and primary care services: Opportunities and challenges for state mental health authorities. Alexandria: National Associatioin of State Mental Health Program Directors(NASMHPD) Medical Directors Council; 2005.Google Scholar
  19. 19.
    Koyanagi C, Garfield R, Howard J, Lyons B. Medicaid policy options for meeting the needs of adults with mental illness under the affordable care act: Kaiser Family Foundation: Health Reform Roundtables: Charting a Course Forward; 2011.Google Scholar
  20. 20.
    Boardman JB. Health access and integration for adults with serious and persistent mental illness. Fam Syst Health. 2006;24(1):3.CrossRefGoogle Scholar
  21. 21.
    Druss BG, Rohrbaugh RM, Levinson CM, Rosenheck RA. Integrated medical care for patients with serious psychiatric illness. Arch Gen Psychiatry. 2001;58:861–8.CrossRefGoogle Scholar
  22. 22.
    HealthNet, Missouri Department of Mental Health and Mental Retardation of Missouri. Progress Report: Missouri CMHC Healthcare Homes: Missouri Department of Mental Health and Missouri HealthNet. 2013.Google Scholar
  23. 23.
    Druss BG, Rohrbaugh RM, Levinson CM, Rosenheck RA. Integrated medical care for patients with serious psychiatric illness: a randomized trial. Arch Gen Psychiatry. 2001;58(9):861–8.CrossRefGoogle Scholar
  24. 24.
    Scharf DM, Eberhart NK, Schmidt N, Vaughan CA, Dutta T, Pincus HA, et al. Integrating primary care into community behavioral health settings: programs and early implementation experiences. Psychiatr Serv. 2013;64:660–5.CrossRefGoogle Scholar
  25. 25.
    USDA. Rural-urban continuum codes. Washington, DC: United States Department of Agriculture Economic Research Service; 2013. http://www.ers.usda.gov/data-products/rural-urban-continuum-codes/.aspx. Accessed March 31 2013Google Scholar
  26. 26.
    United States Census Bureau. Quick Facts: United States. https://www.census.gov/quickfacts/table/PST045216/00 Accessed April 15 2017.
  27. 27.
    Texas Department for State Health Services. Texas Population, 2013 (Estimates). Texas Health and Human Services Commission, Austin. https://www.dshs.state.tx.us/chs/popdat/ST2013.shtm. Accessed August 3 2017.
  28. 28.
    Texas Health and Human Services Commission. Healthcare Statistics. Texas Health and Human Services Commission, Austin, TX. https://hhs.texas.gov/about-hhs/records-statistics/data-statistics/healthcare-statistics. Accessed April 15 2017.
  29. 29.
    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.CrossRefGoogle Scholar
  30. 30.
    Gaynes B BC, Lux LJ, Sheitman B, Ashok M, Boland E, Morgan L, Swinson-Evans T, Whitener L, Viswanathan M. Relationship Between Use of Quality Measures and Improved Outcomes in Serious Mental Illness [Internet]. Rockville (MD): Agency for Healthcare Research and Quality2015 Contract No.: Technical Briefs, No. 18.Google Scholar
  31. 31.
    Levit KR, Friedman B, Wong HS. Estimating inpatient hospital prices from state administrative data and hospital financial reports. Health Serv Res. 2013;48(5):1779–97.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Bureau of Labor Statistics. Databases, Tables & Calculators by Subject. United States Department of Labor. https://www.bls.gov/data/#prices. Accessed April 19 2017.
  33. 33.
    Gleason H, Hobart M, Bradley L, Landers J, Langenfeld S, Tonelli M, et al. Gender differences of mental health consumers accessing integrated primary and behavioral care. Psychol Health Med. 2014;19(2):146–52.CrossRefGoogle Scholar
  34. 34.
    Foundation P. Adult needs and strengths assessment. Chicago: IL; 1999.Google Scholar
  35. 35.
    Goldfield N. The evolution of diagnosis-related groups (DRGs): from its beginnings in case-mix and resource use theory, to its implementation for payment and now for its current utilization for quality within and outside the hospital. Q Manage Health Care. 2010;19(1):3–16.CrossRefGoogle Scholar
  36. 36.
    Shen Y. Applying the 3M all patient refined diagnosis related groups grouper to measure inpatient severity in the VA. Med Care. 2003:II103–I10.Google Scholar
  37. 37.
    Habermeyer B, De Gennaro H, Frizi RC, Roser P, Stulz N. Factors associated with length of stay in a Swiss mental hospital. Psychiatry Q. 2018:1–8.Google Scholar
  38. 38.
    Wooldridge J. Introductory econometrics: a modern approach Mason, OH: Thomson Southwestern; 2003.Google Scholar
  39. 39.
    Manning WG, Mullahy J. Estimating log models: to transform or not to transform? J Health Econ. 2001;20(4):461–94.CrossRefGoogle Scholar
  40. 40.
    Buntin MB, Zaslavsky AM. Too much ado about two-part models and transformation?: comparing methods of modeling Medicare expenditures. J Health Econ. 2004;23(3):525–42.CrossRefGoogle Scholar
  41. 41.
    Halvorsen R, Palmquist R. The interpretation of dummy variables in semilogarithmic equations. Am Econ Rev. 1980;70(3):474–5.Google Scholar
  42. 42.
    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8). JAMA. 2014;311(5):507–20.  https://doi.org/10.1001/jama.2013.284427.CrossRefPubMedGoogle Scholar
  43. 43.
    Atkinson MJ, Zibin S. Evaluative review of quality of life instruments. Quality of life measurement among persons with chronic mental illness: a critique of measures and methods. Vol April 17. Systems for Health Directorate, Health Promotion and Programs Branch, Health Canada: Calgary, Alberta, Canada; 1996.Google Scholar
  44. 44.
    White C, Frimpong E, Huz S, Ronsani A, Radigan M. Effects of the personalized recovery oriented services (PROS) program on hospitalizations. Psychiatry Q. 2018:1–11.Google Scholar
  45. 45.
    Mauer B. Behavioral health/primary care integration and the person-centered healthcare home. Washington, DC: National Council for Community Behavioral Healthcare; 2009.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Management, Policy, and Community HealthThe University of Texas School of Public HealthHoustonUSA
  2. 2.Healthcare Leadership ProgramUniversity College | University of DenverDenverUSA
  3. 3.DSHS Research and Data Analysis, Facilities, Finance, and Analytics Administration, Washington State Department of Social and Health ServicesOlympiaUSA

Personalised recommendations