Poor quality of medical care is a major contributor to excess medical morbidity and premature mortality in persons with serious mental illnesses (SMI). To address this problem, community mental health providers are increasingly partnering with safety net medical providers to develop behavioral health homes, integrated clinics in which persons with SMI receive coordinated medical and mental health care. However, behavioral health homes have faced logistical and privacy challenges in integrating electronic medical records across organizations. This application proposes to develop and test a mobile Personal Health Record (mPHR) to overcome this problem while more fully engaging patients in their health care. The mPHR will have the capability to access medical and mental health medication and lab data in real time;to help clients set and maintain health and lifestyle goals;to provide medication and appointment prompts and reminders;and to facilitate communication with providers via asynchronous communication with the EHRs. This three-phase study will develop, test, and disseminate the mPHR. During the first phase, we will develop the app building on experience and preliminary data from a PC-based PHR project, and link it to the medical and mental health EHR in a behavioral health home. During the second phase, we will conduct a randomized trial of the mPHR in 300 subjects randomized to the mPHR or usual care. The study will use an adaptive design, which will implement the app in five 6-month cohorts of 60 subjects. After each cohort, the app will be updated based on feasibility and acceptability findings, new research and commercial developments in PHR apps, and changes in usual care in the clinic and community practice. Analyses will examine overall effects of the intervention, and whether there is a change in its benefits across study cohorts. Study outcomes will include quality of preventive and cardiovascular care;patient activation and provider management of chronic illness;and service use including medication compliance, missed appointments, emergency department use, and costs of care from a societal and managerial perspective. During the final phase of the intervention, the app will be disseminated to behavioral health homes across the country through a national technical assistance center. The proposed study will apply a novel technology that has not previously been studied in mental health settings, will be conducted in a new organizational model of care that is anticipated to become widespread in community mental health in the coming years, and will use an innovative adaptive design that will ensure that the intervention remains relevant and updated throughout the study period. A multidisciplinary team including mental health services researchers, experts in information technology and app design, and policymakers with expertise in public sector integration will help ensure that the study results will help transform care delivery in mental health safety net settings.
This study will be the first to test a mobile PHR for use in behavioral health homes. If successful, it will provide a vital tool for empowering patients and improving quality of care in these emerging models of service delivery.
