Comprehensive care models are emerging as the new standard for management of patients with chronic disease. These models typically involve a single source of care, such as a medical home, and coordinate a range of medical and psychosocial service interventions using an approach that is both evidence-based and patient-centered. The chronic care model (CCM) as conceptualized by Ed Wagner and colleagues provides a template for the comprehensive care approach. The CCM can be implemented through a medical home, which provides evidence-based care, relies on clinical information systems for active outreach and clinical decision support, and is integrated with a larger set of community resources capable of supporting additional services. Team-based disease management, patient engagement, and active outreach are important elements of the CCM. Treatment approaches emulating the CCM have been particularly successful in the treatment of chronic diseases including diabetes, heart failure, and major depression. Successful models combine both medical management and psychosocial intervention within a team-based approach to care. They use clinical guidelines, chronic disease registries, and active outreach. Although some models engage peers to provide health education and self-management training, generally less emphasis is placed on community linkages. Little work has examined models of comprehensive care for persons with chronic serious mental illness (SMI) such as schizophrenia. Given the debilitating nature of SMI, a comprehensive care model would include access to mental health, physical health, and substance abuse services as well as extensive community linkages, primarily in the form of housing support. This study will examine the comparative effectiveness (a) usual care versus (b) of the Housing First model of comprehensive care, which was implemented throughout California as Full Service Partnerships under the Mental Health Services Act (MHSA). The goal of the MHSA was to achieve a major system redesign, using financial strategies and targeting specific interventions to reduce mental health disparities and to provide comprehensive care to homeless persons with SMI. Although such a model has substantial implementation costs, the high expenses, high hospitalization rates, and severely shortened life expectancy of patients with SMI suggest that many of the intervention costs may be offset by beneficial effects of the program on health outcomes.
Little work has examined models of comprehensive care for persons with chronic serious mental illness (SMI) such as schizophrenia. Given the debilitating nature of SMI, a comprehensive care model would include access to mental health, physical health, and substance abuse services as well as extensive community linkages, primarily in the form of housing support. This study will examine the comparative effectiveness (a) usual care versus (b) of the Housing First model of comprehensive care, which was implemented throughout California as Full Service Partnerships under the Mental Health Services Act (MHSA).
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| Gilmer, Todd P; Stefancic, Ana; Tsemberis, Sam et al. (2014) Full-service partnerships among adults with serious mental illness in California: impact on utilization and costs. Psychiatr Serv 65:1120-5 |
| Gilmer, Todd P; Katz, Marian L; Stefancic, Ana et al. (2013) Variation in the implementation of California's Full Service Partnerships for persons with serious mental illness. Health Serv Res 48:2245-67 |
| Gilmer, Todd P; Stefancic, Ana; Sklar, Marisa et al. (2013) Development and validation of a Housing First fidelity survey. Psychiatr Serv 64:911-4 |
