A behavioral health home can improve health and wellness for people with mental illness

A behavioral health home, a patient-centered way of coordinating care resources, can help people with serious mental illnesses manage their conditions, potentially enabling them to live longer, healthier lives. This PCORI-funded study showed that two ways of providing a behavioral health home to patients with serious mental illnesses, such as bipolar disorder and schizophrenia, are both effective.

The study compared a patient self-directed approach, in which patients used a variety of online resources to manage their health care, to a provider-supported approach, in which patients met with nurses and other clinical staff about managing their care. Both approaches significantly increased patients’ knowledge and confidence to manage their own care, with provider-supported care doing so more quickly. Both approaches also improved patients’ perceived mental health status and increased their engagement in primary and specialty care.

An article published in Health Affairs highlights the study’s results. The research team is exploring ways to implement the behavioral health home model to people who receive care in residential treatment facilities and who attend opioid treatment programs.

Standing exercises improve older adults’ walking skills better than sitting ones

As people age, they face an elevated risk of losing their independence through increasing difficulty in getting around. Exercise may help preserve mobility, but programs offered to older adults typically involve exercises that they do while sitting down. This PCORI-funded study compared the effectiveness of a standing exercise program called On the Move with a seated exercise program. It found that On the Move, with its focus on enhancing motor skills and muscle control necessary for walking, was more effective than the seated exercise program at improving older adults’ function and walking ability in the short term. Although the On the Move group reported a few minor injuries and a somewhat greater discontinuation rate, those in it reported feeling equally safe and satisfied with the more challenging program. The results appear in JAMA Internal Medicine.

Physicians vastly underestimate patients’ willingness to share sexual orientation

If clinicians routinely collected data about sexual orientation from patients, it would significantly boost our ability to identify and address health disparities among lesbian, gay, and bisexual populations. However, health systems are not regularly collecting this information. This study determined that while 80 percent of healthcare professionals believe patients would refuse to provide sexual orientation information if asked, only 10 percent of patients say they would refuse. The results appear in JAMA Internal Medicine and LGBT Health. The New York Times also has a feature on the study.

Oral antibiotics work as well as IV with fewer costly complications

Children taking antibiotics to prevent recurrence of serious infections could remain infection-free, and their families could face fewer costly complications and daily hassles with medical equipment, if the children took the drugs by mouth rather than receiving them through an intravenous line, according to this study. The results appear in JAMA Pediatrics, Pediatrics, and Annals of Surgery. A JAMA Pediatrics commentary says, "the investigators have provided very necessary information about how we can best organize and deliver care to children with a relatively common pediatric diagnosis while improving outcomes, reducing costs and untoward effects, and improving patient satisfaction." Learn more about how these results can inform decisions about treating these infections in a PCORI feature article and a PCORI video.

Blood thinner helps stroke survivors stay in their homes

Using the blood-thinning medicine warfarin enabled stroke survivors, even those over 80, to continue living in their homes longer compared with those who didn’t take the drug, the PROSPER study found. Those taking warfarin stayed in their homes on average 46 more days during the two years after being hospitalized for stroke. Patients advising the researchers said that staying in their homes, rather than being institutionalized in a nursing home or hospital, is the outcome that mattered most. The findings appear in The BMJ. A related editorial calls the study “a solid example of how to refocus research on questions, outcomes, and approaches that could help patients and clinicians to make better healthcare decisions." Learn more about how these results can help stroke survivors gain time at home in a PCORI feature article and a PCORI video.

Pinpointing which people with prediabetes will benefit from preventive drug

Using a benefit prediction model, researchers in this study could identify those patients with prediabetes who are most likely to benefit from taking the diabetes drug metformin—and those likely to suffer more harm than good. Although usually safe, metformin causes a potentially serious side effect called lactic acidosis in some people. Knowing which patients won’t benefit from the drug could reduce the number of people who experience this side effect. The paper appears in The BMJ. The incorporation of this benefit prediction model into an electronic health record is now being tested in 50 clinics via this dissemination project. Learn more about how these results can help identify who benefits from medicine in a PCORI feature article.

Linking people with community resources to reduce childhood obesity

Two approaches to obesity care helped to reduce body mass index (BMI) scores in children who are overweight or have obesity. Both approaches also improved other key health measures and family satisfaction with the children’s care. This study's two approaches both enhanced the usual primary care for childhood obesity by linking families to community resources and sending supportive text messages. Some of the families also received bimonthly coaching on healthy behaviors, which resulted in slightly but not significantly greater reductions in their children’s BMI scores. Results appear in JAMA Pediatrics. Learn more about this study in a PCORI feature article.