Poor quality of care may contribute to impaired health status and excess mortality in individuals with serious mental disorders. However, little work has been done to design or test models for improving these patients' medical care. The application seeks to develop and test a population-based medical case management model for improving primary medical care for patients at an inner-city Community Mental Health Center in Atlanta, Georgia using a randomized, controlled study design. The sample will be drawn from a comprehensive roster of active clients. A total of 400 eligible individuals who agree to participate will be randomly assigned to medical case management or to usual care for two years. For subjects in the intervention group, a manualized, stepped-care case management intervention will provide patient education and activation, communication and advocacy with medical providers, and help in overcoming system-level barriers to primary care. The intervention draws on elements from the primary care, nursing case management, chronic disease, and health behavior change literature, and is based on study team's previous work in integrating primary care services for patients with serious mental illnesses. The primary outcomes of the study will be quality of preventive services and of each of the core domains of primary care. Qualitative data will be collected at the outset and also midway through the study. Secondary outcome measures will include self-reported health status, medical morbidity, and costs. This proposed study will be the first randomized trial of an intervention to improve primary care and health status in a nonintegrated public mental health setting. The results will provide data on the feasibility, outcomes, and costs of medical case management for patients with serious mental illnesses.
