Advertisement

Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness

  • Heidi C. Waters
  • Michael F. Furukawa
  • Shari L. Jorissen
Original Paper
  • 1 Downloads

Abstract

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality, and use of high-cost healthcare services including hospitalizations and emergency department visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study assessed whether there was a predictive relationship between integrated healthcare clinic enrollment and inpatient and emergency department utilization for consumers with SMI when controlling for demographic characteristics and disease severity. While findings indicated no statistically significant impact of integrated care clinic enrollment on utilization, the sample had lower levels of utilization than would have been expected. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.

Keywords

Integrated care Serious mental illness Physical health Utilization 

References

  1. Anderson, G., & Knickman, J. R. (2001). Changing the chronic care system to meet people’s needs. Health Affairs, 20(6), 146–160.  https://doi.org/10.1377/hlthaff.20.6.146.CrossRefPubMedGoogle Scholar
  2. Barry, C. L., & Huskamp, H. A. (2011). Moving beyond parity—mental health and addiction care under the ACA. New England Journal of Medicine, 365(11), 973–975.  https://doi.org/10.1056/NEJMp1108649.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Cahoon, E. K., McGinty, E. E., Ford, D. E., & Daumit, G. L. (2013). Schizophrenia and potentially preventable hospitalizations in the United States: A retrospective cross-sectional study. BMC Psychiatry, 13, 37.  https://doi.org/10.1186/1471-244X-13-37.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Charlson, M., Wells, M. T., Ullman, R., King, F., & Shmukler, C. (2014). The Charlson Comorbidity Index can be used prospectively to identify patients who will incur high future costs. PLoS ONE, 9(12), e112479.  https://doi.org/10.1371/journal.pone.0112479.CrossRefPubMedPubMedCentralGoogle Scholar
  5. D’Hoore, W., Bouckaert, A., & Tilquin, C. (1996). Practical considerations on the use of the Charlson Comorbidity Index with administrative data bases. Journal of Clinical Epidemiology, 49(12), 1429–1433.  https://doi.org/10.1016/S0895-4356(96)00271-5.CrossRefPubMedGoogle Scholar
  6. De Hert, M., Correll, C. U., Bobes, J., Cetkovic-Bakmas, M., Cohen, D., Asai, I., … Leucht, S. (2011). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry, 10(1), 52–77.  https://doi.org/10.1002/j.2051-5545.2011.tb00014.x.
  7. Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613–619.  https://doi.org/10.1016/0895-4356(92)90133-8.CrossRefPubMedGoogle Scholar
  8. Druss, B. G., & Mauer, B. J. (2010). Health care reform and care at the behavioral health–primary care interface. Psychiatric Services, 61(11), 1087–1092.  https://doi.org/10.1176/appi.ps.61.11.1087.CrossRefPubMedGoogle Scholar
  9. Druss, B. G., Rohrbaugh, R. M., Levinson, C. M., & Rosenheck, R. A. (2001). Integrated medical care for patients with serious psychiatric illness: A randomized trial. Archives of General Psychiatry, 58(9), 861–868.  https://doi.org/10.1001/archpsyc.58.9.861.CrossRefPubMedGoogle Scholar
  10. Druss, B. G., Rosenheck, R. A., Desai, M. M., & Perlin, J. B. (2002). Quality of preventive medical care for patients with mental disorders. Medical Care, 40(2), 129–136.  https://doi.org/10.1097/00005650-200202000-00007.CrossRefPubMedGoogle Scholar
  11. Druss, B. G., von Esenwein, S. A., Compton, M. T., Rask, K. J., Zhao, L., & Parker, R. M. (2009). A randomized trial of medical care management for community mental health settings: The Primary Care Access, Referral, and Evaluation (PCARE) study. American Journal of Psychiatry, 167(2), 151–159.  https://doi.org/10.1176/appi.ajp.2009.09050691.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Druss, B. G., von Esenwein, S. A., Glick, G. E., Deubler, E., Lally, C., Ward, M. C., & Rask, K. J. (2016). Randomized trial of an integrated behavioral health home: The Health Outcomes Management and Evaluation (HOME) study. American Journal of Psychiatry.  https://doi.org/10.1176/appi.ajp.2016.16050507.Google Scholar
  13. Ettner, S. L., Frank, R. G., Mark, T., & Smith, M. W. (2000). Risk adjustment of capitation payments to behavioral health care carve-outs: How well do existing methodologies account for psychiatric disability? Health Care Management Science, 3(2), 159–169.  https://doi.org/10.1023/A:1019033105715.CrossRefPubMedGoogle Scholar
  14. Ettner, S. L., Frank, R. G., McGuire, T. G., Newhouse, J. P., & Notman, E. H. (1998). Risk adjustment of mental health and substance abuse payments. Inquiry, 35(2), 223–239. Retrieved from http://www.jstor.org/stable/29772757.
  15. Field, A. (2013). Discovering statistics using IBM SPSS Statistics, 4th ed. Thousand Oaks, CA: SAGE.Google Scholar
  16. Fitch, K., Iwasaki, K., & Villa, K. F. (2014). Resource utilization and cost in a commercially insured population with schizophrenia. American Health and Drug Benefits, 7(1), 18–26. Retrieved from http://www.AHDBonline.com.
  17. Frank, R. G., & Epstein, A. M. (2014). Factors associated with high levels of spending for younger dually eligible beneficiaries with mental disorders. Health Affairs, 33(6), 1006–1013.  https://doi.org/10.1377/hlthaff.2013.0769.CrossRefPubMedGoogle Scholar
  18. Gerrity, M. (2015). Integrating primary care into behavioral health settings: What works for individuals with serious mental illness. Washington, D.C.: Milbank Memorial Fund. Retrieved from www.milbank.org.Google Scholar
  19. Gilmer, T. P., Henwood, B. F., Goode, M., Sarkin, A. J., & Innes-Gomberg, D. (2016). Implementation of integrated health homes and health outcomes for persons with serious mental illness in Los Angeles County. Psychiatric Services, 67(10), 1062–1067.  https://doi.org/10.1176/appi.ps.201500092.CrossRefPubMedGoogle Scholar
  20. Goulet, J. L., Erdos, J., Kancir, S., Levin, F. L., Wright, S. M., Daniels, S. M., … Justice, A. C. (2007). Measuring performance directly using the Veterans Health Administration electronic medical record. Medical Care, 45(1), 73–79.  https://doi.org/10.1097/01.mlr.0000244510.09001.e5.
  21. Heath, B., Romero, W., P., & Reynolds, K. (2013). A standard framework for levels of integrated healthcare. Washington, D.C.: SAMHSA-HRSA Center for Integrated Health Solutions. Retrieved from http://www.integration.samhsa.gov/resource/ standard-framework-for-levels-of-integrated-healthcare.
  22. Heslin, K. C., & Weiss, A. J. (2015). Statistical Brief No. Statistical Brief #189. In Hospital readmissions involving psychiatric disorders, 2012. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  23. Jones, D. R., Macias, C., Barreira, P. J., Fisher, W. H., Hargreaves, W. A., & Harding, C. M. (2004). Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services, 55(11), 1250–1257.  https://doi.org/10.1176/appi.ps.55.11.1250.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Kilbourne, A. M., Biswas, K., Pirraglia, P. A., Sajatovic, M., Williford, W. O., & Bauer, M. S. (2009). Is the collaborative chronic care model effective for patients with bipolar disorder and co-occurring conditions? Journal of Affective Disorders, 112(1–3), 256–261.  https://doi.org/10.1016/j.jad.2008.04.010.CrossRefPubMedGoogle Scholar
  25. Kilbourne, A. M., Lai, Z., Bowersox, N., Pirraglia, P., & Bauer, M. S. (2011). Does colocated care improve access to cardiometabolic screening for patients with serious mental illness? General Hospital Psychiatry, 33, 634–636.  https://doi.org/10.1016/j.genhosppsych.2011.07.003.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Krupski, A., West, I. I., Scharf, D. M., Hopfenbeck, J., Andrus, G., Joesch, J. M., & Snowden, M. (2016). Integrating primary care into community mental health centers: impact on utilization and costs of health care. Psychiatric Services, 67, 1233–1239.  https://doi.org/10.1176/appi.ps.201500424.CrossRefPubMedGoogle Scholar
  27. Laerd Statistics. (2015a). Multiple regression using SPSS Statistics. Statistical tutorials and software guides. Retrieved from https://statistics.laerd.com/.
  28. Laerd Statistics. (2015b). Poisson regression using SPSS Statistics. Statistical tutorials and software guides. Retrieved from https://statistics.laerd.com/.
  29. Li, Y., Glance, L. G., Cai, X., & Mukamel, D. B. (2008). Mental illness and hospitalization for ambulatory care sensitive medical conditions. Medical Care, 46(12), 1249–1256.  https://doi.org/10.1097/MLR.0b013e31817e188c.CrossRefPubMedGoogle Scholar
  30. Manderscheid, R., & Kathol, R. (2014). Fostering sustainable, integrated medical and behavioral health services in medical settings. Annals of Internal Medicine, 160, 61–65.  https://doi.org/10.7326/m13-1693.CrossRefPubMedGoogle Scholar
  31. McCusker, J., Roberge, D., Lévesque, J. F., Ciampi, A., Vadeboncoeur, A., Larouche, D., & Sanche, S. (2010). Emergency department visits and primary care among adults with chronic conditions. Medical Care, 48(11), 972–980.  https://doi.org/10.1097/MLR.0b013e3181eaf86d.CrossRefPubMedGoogle Scholar
  32. McGinty, E. E., Baller, J., Azrin, S. T., Juliano-Bult, D., & Daumit, G. L. (2016). Interventions to address medical conditions and health-risk behaviors among persons with serious mental illness: A comprehensive review. Schizophrenia Bulletin, 42(1), 96–124.  https://doi.org/10.1093/schbul/sbv101.PubMedGoogle Scholar
  33. McGinty, E. E., & Sridhara, S. (2014). Potentially preventable medical hospitalizations among Maryland residents with mental illness, 2005–2010. Psychiatric Services, 65(7), 951–953.  https://doi.org/10.1176/appi.ps.201300323.CrossRefPubMedGoogle Scholar
  34. Minassian, A., Vilke, G. M., & Wilson, M. P. (2013). Frequent emergency department visits are more prevalent in psychiatric, alcohol abuse, and dual diagnosis conditions than in chronic viral illnesses such as hepatitis and human immunodeficiency virus. Journal of Emergency Medicine, 45(4), 520–525.  https://doi.org/10.1016/j.jemermed.2013.05.007.CrossRefPubMedGoogle Scholar
  35. Mitchell, A. J., & Lawrence, D. (2011). Revascularisation and mortality rates following acute coronary syndromes in people with severe mental illness: comparative meta-analysis. British Journal of Psychiatry, 198(6), 434–441.  https://doi.org/10.1192/bjp.bp.109.076950.CrossRefPubMedGoogle Scholar
  36. Nussbaum, E. M., Elsadat, S., & Khago, A. H. (2008). Best practices in analyzing count data: Poisson regression. In J. Osborne (Ed.), Best practices in quantitative methods (pp. 306–323). Thousand Oaks, CA: SAGE. Retrieved from http://jwosborne.com/bp_ch21.html.
  37. Oster, A., & Bindman, A. B. (2003). Emergency department visits for ambulatory care sensitive conditions: Insights into preventable hospitalizations. Medical Care, 41(2), 198–207.  https://doi.org/10.1097/01.mlr.0000045021.70297.9f.PubMedGoogle Scholar
  38. Pirraglia, P. A., Kilbourne, A. M., Lai, Z., Friedmann, P. D., & O’Toole, T. P. (2011). Colocated general medical care and preventable hospital admissions for veterans with serious mental illness. Psychiatric Services, 62(5), 554–557.  https://doi.org/10.1176/appi.ps.62.5.554.CrossRefPubMedGoogle Scholar
  39. Pirraglia, P. A., Rowland, E., Wu, W.-C., Friedmann, P. D., O’Toole, T. P., Cohen, L. B., & Taviera, T. H. (2012). Benefits of a primary care clinic collocated and integrated in a mental health setting for veterans with serious mental illness. Preventing Chronic Disease, 9, E51. . https://doi.org/10.5888/pcd9.110113.PubMedPubMedCentralGoogle Scholar
  40. Randall, I., Mohr, D. C., & Maynard, C. (2014). VHA patient-centered medical home associated with lower rate of hospitalizations and specialty care among veterans with posttraumatic stress disorder. Journal for Healthcare Quality.  https://doi.org/10.1111/jhq.12092.Google Scholar
  41. Salsberry, P. J., Chipps, E., & Kennedy, C. (2005). Use of general medical services among Medicaid patients with severe and persistent mental illness. Psychiatric Services, 56, 458–462.  https://doi.org/10.1176/appi.ps.56.4.458.CrossRefPubMedGoogle Scholar
  42. Schaps, M., & Post, S. (2015). Best practices in behavioral–physical health integration. Chicago, IL: Health and Medicine Policy Working Group. Retrieved from hmprg.org.
  43. Shanmugam, R. (2007). Poisson distribution. In N. Salkind (Ed.), Encyclopedia of measurement and statistics (Vol. 3, pp. 773–776). Thousand Oaks, CA: SAGE.  https://doi.org/10.4135/9781412952644.n350.Google Scholar
  44. Solberg, L. I., Crain, A. L., Jaeckels, N., Ohnsorg, K. A., Margolis, K. L., Beck, A., … Van de Ven, A. H. (2013). The DIAMOND initiative: Implementing collaborative care for depression in 75 primary care clinics. Implementation Science, 8, 135.  https://doi.org/10.1186/1748-5908-8-135.
  45. Substance Abuse and Mental Health Services Administration (SAMHSA). (2013). Results from the 2012 National Survey on Drug Use and Health: Mental health findings (NSDUH Series H-47 No. SMA 13-4805). Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  46. Substance Abuse and Mental Health Services Administration (SAMHSA). (2014, December 19). Primary and behavioral health care integration. Retrieved July 30, 2015, from http://www.samhsa.gov/grants/grant-announcements/sm-15-005.
  47. Tang, N., Stein, J., Hsia, R. Y., Maselli, J. H., & Gonzales, R. (2010). Trends and characteristics of US emergency department visits, 1997–2007. Journal of the American Medical Association, 304(6), 664–670.  https://doi.org/10.1001/jama.2010.1112.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Thiejke, S., Vannoy, S., & Unutzer, J. (2007). Integrating mental health and primary care. Primary Care Clinical Office Practice, 34, 571–592.  https://doi.org/10.1016/j.pop.2007.05.007.CrossRefGoogle Scholar
  49. Thornicroft, G. (2011). Physical health disparities and mental illness: The scandal of premature mortality. British Journal of Psychiatry, 199, 441–442.  https://doi.org/10.1192/bjp.bp.111.092718.CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Heidi C. Waters
    • 1
    • 2
  • Michael F. Furukawa
    • 1
  • Shari L. Jorissen
    • 1
  1. 1.College of Health SciencesWalden UniversityMinneapolisUSA
  2. 2.Marco IslandUSA

Personalised recommendations