Findings of excess cardio metabolic morbidity and mortality in persons with severe mental illness (SMI) have led to a growing interest by Community Mental Health Centers (CMHCs) in improving the medical care of the populations they treat. However, these organizations face a number of financial and organizational barriers to implementing and sustaining such programs. In previous and ongoing work, the study team has documented the promise of team-based models in improving health and health care in this population. This study will test a novel approach for improving mental health consumers based on a partnership model between a CMHC and a Community Health Center (CHC). This partnership will capitalize on collocation of services, the primary care expertise of the CHC, and favorable reimbursement conditions, to develop a program that is both clinically robust and financially and organizationally sustainable A total of 300 CMHC clients with a severe mental illness and one or more active cardio metabolic problem (diabetes, hypertension, hyperlipidemia) will be randomized to either onsite Integrated Community Care (ICC) (n=150) or to a referral to the partner community health center (CHC) (n=150) for their medical problems. For those in the ICC, the CHC will establish a satellite clinic at the CMHC staffed by a physician assistant and care manager. The ICC will provide care for both the index cardio metabolic conditions and common acute and chronic comorbidities. The study will use standardized, validated instruments to assess the impact of integrated community care on quality and outcomes of cardio metabolic and general medical care. A budget impact analysis and qualitative case study analysis will be used to assess the program's financial and organizational sustainability. The program will be disseminated in partnership with the National Council on Community Behavioral healthcare, the oldest and largest trade organization of community mental health organizations. When this study is completed, it will provide a model for CMHCs to provide a medical home for the populations they serve.

Public Health Relevance

There is an urgent need to develop practical, sustainable approaches to improving medical care for persons treated in community mental health settings. This study will test a novel approach for improving mental health consumers based on a partnership model between a Community Mental Health Center and a Community Health Center. When this study is completed, it will provide a model for a medical home for persons with severe mental illness that is clinically robust, and organizationally and financially sustainable.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH070437-10
Application #
8596848
Study Section
Special Emphasis Panel (ZMH1-ERB-B (06))
Program Officer
Azrin, Susan
Project Start
2004-07-01
Project End
2014-12-31
Budget Start
2014-01-01
Budget End
2014-12-31
Support Year
10
Fiscal Year
2014
Total Cost
$510,701
Indirect Cost
$178,485
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
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