Optimizing Behavioral Health Homes for Adults With Serious Mental Illness
| Status: | Completed |
|---|---|
| Conditions: | Peripheral Vascular Disease, Cardiology, Psychiatric, Psychiatric, Diabetes |
| Therapuetic Areas: | Cardiology / Vascular Diseases, Endocrinology, Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 2/23/2018 |
| Start Date: | October 2013 |
| End Date: | January 2017 |
Optimizing Behavioral Health Homes by Focusing on Outcomes That Matter Most for Adults With Serious Mental Illness
Adults with serious mental illness (SMI) frequently have unmet medical needs which place them
at risk for adverse health outcomes. While there are proven ways to manage and/or prevent
serious medical conditions common among this population, information is needed to understand
their impact on outcomes that matter most for patients, particularly in community mental
health centers (CMHCs) where most adults with SMI receive their care and rural areas where
locating and receiving health care services can be challenging.
The investigators will test two promising ways for promoting the health, wellness, and
recovery of adults with SMI. One way will help patients manage their health and health care
through self-management strategies, including the use of a web portal, and peer support
(patient self-directed care) and the other through interactions with nurses during clinic
visits (provider-supported integrated care).
The investigators will compare the two interventions on three primary patient-centered
outcomes (i.e. patient activation in care, health status, engagement in primary/specialty
care). The investigators hypothesize that:
1. Patient self-directed care will result in improvement in patient activation.
2. Provider-supported integrated care will result in greater improvement in frequency in
primary/specialty care visits.
3. Both interventions will result in significant improvements in the three primary
outcomes.
The investigators will collect information from patients, caregivers, and clinic staff at
different points in time during the study. Patients will be asked to complete questionnaires
and additional data on their service use will be gathered. Some patients and providers will
also be interviewed about their experiences with care. The investigators will examine these
data to learn if, how, and why the new services improve outcomes over time. This information
will help us understand patient and other stakeholder views about the services and, if
appropriate, ensure their continued and/or expanded availability.
at risk for adverse health outcomes. While there are proven ways to manage and/or prevent
serious medical conditions common among this population, information is needed to understand
their impact on outcomes that matter most for patients, particularly in community mental
health centers (CMHCs) where most adults with SMI receive their care and rural areas where
locating and receiving health care services can be challenging.
The investigators will test two promising ways for promoting the health, wellness, and
recovery of adults with SMI. One way will help patients manage their health and health care
through self-management strategies, including the use of a web portal, and peer support
(patient self-directed care) and the other through interactions with nurses during clinic
visits (provider-supported integrated care).
The investigators will compare the two interventions on three primary patient-centered
outcomes (i.e. patient activation in care, health status, engagement in primary/specialty
care). The investigators hypothesize that:
1. Patient self-directed care will result in improvement in patient activation.
2. Provider-supported integrated care will result in greater improvement in frequency in
primary/specialty care visits.
3. Both interventions will result in significant improvements in the three primary
outcomes.
The investigators will collect information from patients, caregivers, and clinic staff at
different points in time during the study. Patients will be asked to complete questionnaires
and additional data on their service use will be gathered. Some patients and providers will
also be interviewed about their experiences with care. The investigators will examine these
data to learn if, how, and why the new services improve outcomes over time. This information
will help us understand patient and other stakeholder views about the services and, if
appropriate, ensure their continued and/or expanded availability.
The combination of high medical need with difficulty accessing quality medical care makes
adults with serious mental illness (SMI) one of our nation's most medically vulnerable
populations. While evidence-based interventions exist for managing and/or preventing high
rates of chronic medical conditions in this population, information is needed to understand
their impact on outcomes that matter most for patients, particularly in community mental
health centers (CMHCs) where most adults with SMI receive their care and rural areas where
availability of and access to health care services is limited.
Building on the work of a multi-stakeholder collaboration in rural Pennsylvania, the UPMC
Center for High-Value Health Care and our patient, provider, and payer partners will evaluate
two promising interventions—patient self-directed care and provider-supported integrated
care—for promoting the health, wellness, and recovery of adults with SMI. We will address
four questions that patients have identified as important to them:
1. Given my mental and physical conditions, what should I expect will happen to my overall
health, wellness, and recovery when I engage in the new services offered by my CMHC?
2. If I choose to participate in these services, what are the potential advantages or
disadvantages to me?
3. In what ways can I become more active in managing my own health and health care?
4. Which of the services that my CMHC could make available to me will impact outcomes that
I care about and help me make the best decisions about my health and care? Our aims
compare the effectiveness of the interventions on patient-centered outcomes and explore
the moderating role of patient characteristics and the mediating role of engagement in
the interventions. By demonstrating which interventions improve outcomes for whom under
what circumstances, we will inform positive patient heath choices and key stakeholder
decision making to support these choices, thereby advancing health system improvement
efforts to avoid early mortality and comorbidity in this population.
We have enrolled 1,229 Medicaid-enrolled adults who have or are at risk for chronic medical
conditions and receive care at rural and suburban CMHCs. Using a cluster randomized design
with a mixed-methods approach, we randomly assigned 11 CMHCs to one of the two interventions.
Quantitative (self-report, claims, process) and qualitative (interviews) data will be
gathered across multiple time points from baseline through the end of the two-year
intervention. Descriptive and multivariate analyses will be used to examine the impact of the
interventions on outcomes over time and explore the roles of moderating and mediating
variables. Qualitative results will be used to understand patient and other stakeholder
perspectives and promote dissemination and sustainability.
adults with serious mental illness (SMI) one of our nation's most medically vulnerable
populations. While evidence-based interventions exist for managing and/or preventing high
rates of chronic medical conditions in this population, information is needed to understand
their impact on outcomes that matter most for patients, particularly in community mental
health centers (CMHCs) where most adults with SMI receive their care and rural areas where
availability of and access to health care services is limited.
Building on the work of a multi-stakeholder collaboration in rural Pennsylvania, the UPMC
Center for High-Value Health Care and our patient, provider, and payer partners will evaluate
two promising interventions—patient self-directed care and provider-supported integrated
care—for promoting the health, wellness, and recovery of adults with SMI. We will address
four questions that patients have identified as important to them:
1. Given my mental and physical conditions, what should I expect will happen to my overall
health, wellness, and recovery when I engage in the new services offered by my CMHC?
2. If I choose to participate in these services, what are the potential advantages or
disadvantages to me?
3. In what ways can I become more active in managing my own health and health care?
4. Which of the services that my CMHC could make available to me will impact outcomes that
I care about and help me make the best decisions about my health and care? Our aims
compare the effectiveness of the interventions on patient-centered outcomes and explore
the moderating role of patient characteristics and the mediating role of engagement in
the interventions. By demonstrating which interventions improve outcomes for whom under
what circumstances, we will inform positive patient heath choices and key stakeholder
decision making to support these choices, thereby advancing health system improvement
efforts to avoid early mortality and comorbidity in this population.
We have enrolled 1,229 Medicaid-enrolled adults who have or are at risk for chronic medical
conditions and receive care at rural and suburban CMHCs. Using a cluster randomized design
with a mixed-methods approach, we randomly assigned 11 CMHCs to one of the two interventions.
Quantitative (self-report, claims, process) and qualitative (interviews) data will be
gathered across multiple time points from baseline through the end of the two-year
intervention. Descriptive and multivariate analyses will be used to examine the impact of the
interventions on outcomes over time and explore the roles of moderating and mediating
variables. Qualitative results will be used to understand patient and other stakeholder
perspectives and promote dissemination and sustainability.
Inclusion Criteria:
- Adults age 18 and older
- Serious mental illness (schizophrenia, bipolar disorder, major depression)
- Receive services at one of the 11 participating community mental health centers
- At least one claim for outpatient case management or peer specialist services
Exclusion criteria:
- Not willing to provide informed consent
- Assessed by clinicians as being too ill to be treated on an outpatient basis
- Unable to speak, read, or understand English at the minimum required level
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