Optimizing Behavioral Health Homes by Focusing On Outcomes That Matter Most for Adults with Serious Mental Illness
Background: Adults with serious mental illness (SMI) frequently have unmet medical needs that 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 healthcare services can be challenging.
Objectives: Building on the work of a group of stakeholders in rural Pennsylvania, the UPMC Center for High-Value Health Care and our patient, provider, and payer partners 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 a Web-based portal and peer support and the other through interactions with nurses during clinic visits.
We will address four questions that patients have identified as important to them:
- 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?
- If I choose to participate in these services, what are the potential advantages or disadvantages to me?
- In what ways can I become more active in managing my own health and health care?
- 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?
We will compare the impact of these services on outcomes of interest to patients and explore how patient characteristics and level of involvement in services affect outcomes. By showing which services 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 untimely death and disease in this population.
Methods: We will target 2,810 Medicaid-enrolled adults who have or are at risk for chronic medical conditions and receive care at rural CMHCs for participation. Eight CMHCs will be randomly assigned to one of the two services with an estimated 1,124 patients involved in each group of four clinics. We 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. We 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.
Kogan JN, Schuster J, Nikolajski C, Schake P, Carney T, Morton SC, Kang C, Reynolds CF 3rd. Challenges encountered in the conduct of Optimal Health: A patient-centered comparative effectiveness study of interventions for adults with serious mental illness. Clin Trials. 2016 Sep 28. pii: 1740774516670895. [Epub ahead of print] PubMed PMID: 27681658. (Abstract only available)