Project Wellness Enhancement: Increasing Health Care Choice and Outcomes for People With Mental Illness

Background: Americans with serious mental illnesses (SMI) die an average of 25 years earlier
due to modifiable risk factors, medical conditions, and lack of access to quality,
coordinated care. Strategies for addressing this disparity have amassed evidence. What
remains to be determined is who will choose to use these evidence-based practices (EBPs) when
implemented in routine practice, in what combinations, with what short term effects and
health outcomes, and what else might be needed for persons for whom these strategies are not
effective.

Objectives: The proposed research builds upon the investigators receipt of a SAMHSA grant
that established an integrated Wellness Center (WC) within the local mental health center
that provides four EBPs: a) on-site primary care; b) screening of clients for modifiable risk
factors and medical conditions; c) care coordination; and d) peer health navigation. Through
PCORI, the investigators propose to add a comparative effectiveness dimension and a focus on
patient-centered outcomes. The investigators specific aims are:

1. to assess patient preferences and use of services, short-term effects, and longer term
outcomes associated with various practices for the population and subpopulations;

2. to identify barriers to and facilitators of access, service use, and improvements in
traditional and patient-centered health outcomes; and

3. to develop and pilot a peer-led, community-based intervention in enhancing access and
choice, and improving patient-centered health outcomes, among 40 treatment-refractory
clients of the WC.

The investigators long-term objectives are to: a) identify which practices work for which
persons with SMI in improving health and patient-centered outcomes, and b) provide
stakeholders around the nation with the knowledge and tools to replicate this model
efficiently, effectively, and broadly.

Methods: The sample includes 360 poor, urban adults with SMI who are at risk for or have
co-morbid medical conditions. Using participatory and mixed methodology, the investigators
will assess Specific Aims 1 & 2 by collecting health and patient-centered outcome data on
patients entering the WC and at 6 month follow-up intervals and analyze the data using Linear
Mixed Models and logistic regression. Outcome data from the pilot intervention (Aim 3; N=40)
will be compared to outcomes of a propensity matched sample of WC patients. Qualitative data
will be collected each year through focus groups (N=48 agency stakeholders, year 1) and
individual interviews (50 WC patients, years 2 & 3).

Projected Patient Outcomes: Outcomes include both traditional medical/clinical outcomes
(e.g., blood pressure, BMI, fasting plasma glucose, HbGA1c, cholesterol, triglycerides,
alcohol and drug use, psychiatric symptoms) and a range of patient-centered outcomes to be
identified by key stakeholders in the initial phase of research. The investigators previous
research suggests that these outcomes are likely to include self-efficacy, quality of life,
employment, citizenship, and social connectedness.

Inclusion Criteria:

- 18 years or older

- Clients receiving services from CMHC and the Wellness Center.

- Research staff will verify with CMHC staff that the potential participant is receiving
services currently at CMHC.

- Provider research subjects will be included if they are a mental health provider at
CMHC or if they are members of the staff for the Wellness Center

- Adults with serious mental illness and physical illness

Exclusion Criteria:

- Participant research subjects not receiving services at CMHC and the Wellness Center

- Provider research subjects of other agencies will be excluded

- Children and youth under 18 years of age