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 in community mental health settings. The application seeks to develop and test a population-based medical case management model for improving general medical care for patients at an inner-city Community Mental Health Center in Atlanta, Georgia using a randomized, controlled study design. 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 care 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. This proposed study will be the first randomized trial of an intervention to improve health and health care in a nonintegrated public mental health setting. The results will provide data on the feasibility and outcomes of medical care management for patients with serious mental illnesses in community mental health settings.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH070437-05
Application #
7386643
Study Section
Services Research Review Committee (SRV)
Program Officer
Azrin, Susan
Project Start
2004-07-01
Project End
2009-12-31
Budget Start
2008-04-01
Budget End
2009-12-31
Support Year
5
Fiscal Year
2008
Total Cost
$624,659
Indirect Cost
Name
Emory University
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Krishan, Shaily; von Esenwein, Silke A; Druss, Benjamin G (2012) The health literacy of adults with severe mental illness. Psychiatr Serv 63:397
Druss, Benjamin G; von Esenwein, Silke A; Compton, Michael T et al. (2011) Budget impact and sustainability of medical care management for persons with serious mental illnesses. Am J Psychiatry 168:1171-8
Druss, Benjamin G; von Esenwein, Silke A; Compton, Michael T et al. (2010) A randomized trial of medical care management for community mental health settings: the Primary Care Access, Referral, and Evaluation (PCARE) study. Am J Psychiatry 167:151-9
Marshall, Deborah A; Johnson, F Reed; Kulin, Nathalie A et al. (2009) How do physician assessments of patient preferences for colorectal cancer screening tests differ from actual preferences? A comparison in Canada and the United States using a stated-choice survey. Health Econ 18:1420-39
Druss, Benjamin G; Rask, Kimberly; Katon, Wayne J (2008) Major depression, depression treatment and quality of primary medical care. Gen Hosp Psychiatry 30:20-5
Druss, Benjamin G; Henderson, Kathy L; Rosenheck, Robert A (2007) Swept away: use of general medical and mental health services among veterans displaced by Hurricane Katrina. Am J Psychiatry 164:154-6
Druss, Benjamin G (2007) Do we know need when we see it? Psychiatr Serv 58:295
Druss, Benjamin G; von Esenwein, Silke A (2006) Improving general medical care for persons with mental and addictive disorders: systematic review. Gen Hosp Psychiatry 28:145-53
Druss, Benjamin G; Bornemann, Thomas; Fry-Johnson, Yvonne W et al. (2006) Trends in Mental Health and Substance Abuse Services at the Nation's Community Health Centers: 1998-2003. Am J Public Health 96:1779-84