Skip to main content

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



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.


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.


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).


A primary care medical home for serious mental illness can be feasible to implement, safe, and more effective than usual care.

Trial Registration. Identifier: NCT01668355.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Walker ER, McGee RE, Druss BG. Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA Psychiatry. 2015;72(4):334-41.

    Article  Google Scholar 

  2. Doran KM, Raven MC, Rosenheck RA. What drives frequent emergency department use in an integrated health system? National data from the Veterans Health Administration. Ann Emerg Med. 2013;62(2):151-9.

    Article  Google Scholar 

  3. Lichstein JC, Domino ME, Beadles CA, et al. Use of medical homes by patients with comorbid physical and severe mental illness. Med Care. 2014;52(Suppl 2)(3):S85-91.

  4. Druss B, Rosenheck R, Desai M, Perlin J. Quality of preventive medical care for patients with mental disorders. Med Care. 2002;40:129–136.

    Article  Google Scholar 

  5. Piette JD, Heisler M, Ganoczy D, McCarthy JF, Valenstein M. Differential medication adherence among patients with schizophrenia and comorbid diabetes and hypertension. Psychiatr Serv. 2007;58(2):207-12.

    Article  Google Scholar 

  6. DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101-7.

    CAS  Article  Google Scholar 

  7. Institute of Medicine. Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. National Academies Press; 2006.

  8. Corrigan PW, Mittal D, Reaves CM, et al. Mental health stigma and primary health care decisions. Psychiatry Res. 2014;218(1-2):35-8.

  9. Sanchez K. Collaborative care in real-world settings: barriers and opportunities for sustainability. Patient Preference and Adherence. 2017;11:71-74.

    Article  Google Scholar 

  10. Benzer JK, Beehler S, Miller C, et al. Grounded theory of barriers and facilitators to mandated implementation of mental health care in the primary care setting. Depress Res Treat. 2012;2012:1-11. 597157.

  11. Tai-Seale M, Kunik ME, Shepherd A, Kirchner J, Gottumukkala A. A case study of early experience with implementation of collaborative care in the Veterans Health Administration. Popul Health Manag. 2010;13(6):331-7.

    Article  Google Scholar 

  12. Gerrity M. Integrating Primary Care into Behavioral Health Settings: What Works for Individuals with Serious Mental Illness. 2014. Accessed September 17, 2019.

  13. Bodenheimer T. Strategies to reduce costs and improve care for high-utilizing medicaid patients: reflections on pioneering programs. 2013. Accessed September 17, 2019.

  14. Bradford DW, Cunningham NT, Slubicki MN, et al. An evidence synthesis of care models to improve general medical outcomes for individuals with serious mental illness: a systematic review. J Clin Psychiatry. 2013;74(8):e754-64.

    Article  Google Scholar 

  15. Druss BG, Mauer BJ. Health care reform and care at the behavioral health-primary care interface. Psychiatr Serv. 2010;61(11):1087-92.

    Article  Google Scholar 

  16. Grove LR, Gertner AK, Swietek KE, et al. Effect of enhanced primary care for people with serious mental illness on service use and screening. J Gen Intern Med. 2021;36(4):970-977.

    Article  Google Scholar 

  17. Shim RS, Lally C, Farley R, Ingoglia C, Druss BG. Medical care services in community mental health centers: a national survey of psychiatrists. Journal of Behavioral Health Services & Research. 2015;42(3):395-400.

    Article  Google Scholar 

  18. Chang ET, Vinzon M, Cohen AN, Young AS. Effective models urgently needed to improve physical care for people with serious mental illnesses. Health Serv Insights. 2019;12:1-4.

    Google Scholar 

  19. Young AS, Cohen AN, Chang ET, et al. A clustered controlled trial of the implementation and effectiveness of a medical home to improve health care of people with serious mental illness: study protocol. BMC Health Serv Res. 2018;18(1):428.

    Article  Google Scholar 

  20. Fisher DG, Pilon D, Hershberger SL, Reynolds GL, LaMaster SC, Davis M. Psychometric properties of an assessment for mental health recovery programs. Community Ment Health J. 2009;45(4):246-50.

    CAS  Article  Google Scholar 

  21. Wang L, Porter B, Maynard C, et al. Predicting risk of hospitalization or death among patients receiving primary care in the Veterans Health Administration. Med Care. 2013;51(4):368-73.

    Article  Google Scholar 

  22. Rosland AM, Nelson K, Sun H, et al. The patient-centered medical home in the Veterans Health Administration. Am J Manag Care. 2013;19(7):e263-72.

    PubMed  Google Scholar 

  23. Post EP, Van Stone WW. Veterans Health Administration primary care-mental health integration initiative. N C Med J. 2008;69(1):49-52.

    PubMed  Google Scholar 

  24. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4.

  25. Ritchie MJ. Implementation Facilitation Training Manual. 2017. Available from: Accessed November 24, 2019.

  26. Glasgow RE, Wagner EH, Schaefer J, Mahoney LD, Reid RJ, Greene SM. Development and validation of the Patient Assessment of Chronic Illness Care (PACIC). Med Care. 2005;43(5):436-44.

    Article  Google Scholar 

  27. Safran DG, Karp M, Coltin K, et al. Measuring patients' experiences with individual primary care physicians. J Gen Intern Med. 2006;21(1):13-21.

    Article  Google Scholar 

  28. Selim AJ, Rogers W, Fleishman JA, et al. Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Qual Life Res. 2009;18(1):43-52.

    Article  Google Scholar 

  29. Eisen SV, Normand SL, Belanger AJ, Spiro A, III, Esch D. The Revised Behavior and Symptom Identification Scale (BASIS-R): reliability and validity. Med Care. 2004;42(12):1230-41.

    Article  Google Scholar 

  30. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Serv Res. 2005;40(6 Pt 1):1918-30.

    Article  Google Scholar 

  31. 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.

    CAS  Article  Google Scholar 

  32. Bauer MS, McBride L, Williford WO, et al. Collaborative care for bipolar disorder: part II: impact on clinical outcome, function, and costs. Psychiatr Serv. 2006;57(7):937-45.

    Article  Google Scholar 

  33. Kilbourne AM, Post EP, Nossek A, Drill L, Cooley S, Bauer MS. Improving medical and psychiatric outcomes among individuals with bipolar disorder: a randomized controlled trial. Psychiatr Serv. 2008;59(7):760-8.

    Article  Google Scholar 

  34. Druss BG, von Esenwein SA, Compton MT, Rask KJ, Zhao L, Parker RM. A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study. Am J Psychiatry. 2010;167(2):151-9.

    Article  Google Scholar 

  35. Concato J, Shah N, Horwitz RI. Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs. N Engl J Med. 2000;342(25):1887-92.

    CAS  Article  Google Scholar 

Download references


The authors thank Merlyn Vinzon for provision of patient care, Lisa Rubinstein for consultations on project design, and Karen Chu for contributions to data analysis. The contents of this publication and the views expressed therein do not necessarily represent the views of the Department of Veterans Affairs, the American Psychiatric Association, or affiliated institutions.


This research was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Serve Quality Enhancement Research Initiative (SDP 12–177) and VISN-22 Mental Illness Research, Education and Clinical Center (MIRECC).

Author information

Authors and Affiliations



Authors Young, Cohen, and Oberman had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Young, Cohen, E. Chang, Hamilton.

Acquisition of data: Young, Cohen, E. Chang, D Chang, Lindamer, Oberman.

Analysis and interpretation of data: Young, Cohen, E. Chang, D. Chang, Hamilton, Lindamer, Oberman, Sanford, Whelan.

Drafting of manuscript: Young, Sanford, E. Chang.

Critical revision of the manuscript for important intellectual content: Young, Cohen, Sanford, E. Chang, D. Chang, Hamilton, Lindamer, Oberman, Whelan.

Statistical analysis: Young, Cohen, Sanford, Whelan.

Obtained funding: Young, Cohen, Hamilton.

Administrative, technical, or material support: Oberman.

Study supervision: Young, D. Chang, Oberman, Lindamer.

Corresponding author

Correspondence to Alexander S. Young MD, MSHS.

Ethics declarations

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Prior Presentations

1. Young AS, Chang ET, Cohen AN, Chang DT, Hamilton AB, Lindamer LA, Oberman R, Whelan F: The Implementation and Effectiveness of a Specialized Primary Care PACT to Improve the Health Care of Veterans with Serious Mental Illness. Research presentation at the 2019 VA HSR&D QUERI National Conference, Washington DC, October 31, 2019.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Young, A., Chang, E., Cohen, A. et al. The Effectiveness of a Specialized Primary Care Medical Home for Patients with Serious Mental Illness. J GEN INTERN MED (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


  • Care coordination
  • Patient centered medial home
  • Screening
  • Behavioral health
  • Health system, hospital or practice redesign
  • Disparities
  • Veteran care