Community Mental Health Center Integrated Care Outcomes
Despite the compelling logic for integrating care for people with serious mental illness, there is also need for quantitative evidence of results. This retrospective analysis used 2013–2015 data from seven community mental health centers to measure clinical processes and health outcomes for patients receiving integrated primary care (n = 18,505), as well as hospital use for the 3943 patients with hospitalizations during the study period. Bivariate and regression analyses tested associations between integrated care and preventive screening rates, hemoglobin A1c levels, and hospital use. Screening rates for body-mass index, blood pressure, smoking, and hemoglobin A1c all increased very substantially during integrated care. More than half of patients with baseline hypertension had this controlled within 90 days of beginning integrated care. Among patients hospitalized at any point during the study period, the probability of hospitalization in the first year of integrated care decreased by 18 percentage points, after controlling for other factors such as patient severity, insurance status, and demographics (p < .001). The average length of stay was also 32% shorter compared to the year prior to integrated care (p < .001). Savings due to reduced hospitalization frequency alone exceeded $1000 per patient. Data limitations restricted this study to a pre−/post-study design. However, the magnitude and consistency of findings across different outcomes suggest that for people with serious mental illness, integrated care can make a significant difference in rates of preventive care, health, and cost-related outcomes.
KeywordsIntegration Community mental health center Primary care Preventive screening Hypertension Hospital use
This study was funded by the Meadows Mental Health Policy Institute, the Texas Health and Human Services Commission, and the Centers for Medicare and Medicaid Services (#11-W-00278/6). The findings are those of the authors and do not necessarily represent the official position of the funders.
Compliance with Ethical Standards
Conflict of Interest
Rebecca Wells declares that she has no conflict of interest.
Bobbie Kite declares that she has no conflict of interest.
Ellen Breckenridge declares that she has no conflict of interest.
Tenaya Sunbury declares that she has no conflict of interest.
All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Because the data in this study derived from agency records, the principal investigator’s IRB waived informed consent as infeasible to obtain. Analyses were conducted only on de-identified data.
- 1.Gaynes B, Brown C, Lux LJ, Sheitman B, Ashok M, Boland E et al. Relationship between use of quality measures and improved outcomes in serious mental illness. Rockville, MD: Agency for Healthcare Research and Quality2015 Contract No.: AHRQ Publication No. 15-EHC003-EF.Google Scholar
- 2.Parks J, Svendsen D, Singer P, Foti ME, Mauer B. Morbidity and mortality in people with serious mental illness. Alexandria: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council; 2006.Google Scholar
- 3.Lutterman T, Ganju V, Schacht L, Shaw R, Monihan K, Huddle M. Sixteen state study on mental health performance measures. 2003.Google Scholar
- 6.MO Department of Mental Health, HealthNet. Progress report: Missouri CMHC healthcare homes: MO Department of Mental Health and MO HealthNet. 2013.Google Scholar
- 18.Parks J, Pollack D, Bartels S, Mauer B. Integrating behavioral health and primary care services: Opportunities and challenges for state mental health authorities. Alexandria: National Associatioin of State Mental Health Program Directors(NASMHPD) Medical Directors Council; 2005.Google Scholar
- 19.Koyanagi C, Garfield R, Howard J, Lyons B. Medicaid policy options for meeting the needs of adults with mental illness under the affordable care act: Kaiser Family Foundation: Health Reform Roundtables: Charting a Course Forward; 2011.Google Scholar
- 22.HealthNet, Missouri Department of Mental Health and Mental Retardation of Missouri. Progress Report: Missouri CMHC Healthcare Homes: Missouri Department of Mental Health and Missouri HealthNet. 2013.Google Scholar
- 25.USDA. Rural-urban continuum codes. Washington, DC: United States Department of Agriculture Economic Research Service; 2013. http://www.ers.usda.gov/data-products/rural-urban-continuum-codes/.aspx. Accessed March 31 2013Google Scholar
- 26.United States Census Bureau. Quick Facts: United States. https://www.census.gov/quickfacts/table/PST045216/00 Accessed April 15 2017.
- 27.Texas Department for State Health Services. Texas Population, 2013 (Estimates). Texas Health and Human Services Commission, Austin. https://www.dshs.state.tx.us/chs/popdat/ST2013.shtm. Accessed August 3 2017.
- 28.Texas Health and Human Services Commission. Healthcare Statistics. Texas Health and Human Services Commission, Austin, TX. https://hhs.texas.gov/about-hhs/records-statistics/data-statistics/healthcare-statistics. Accessed April 15 2017.
- 30.Gaynes B BC, Lux LJ, Sheitman B, Ashok M, Boland E, Morgan L, Swinson-Evans T, Whitener L, Viswanathan M. Relationship Between Use of Quality Measures and Improved Outcomes in Serious Mental Illness [Internet]. Rockville (MD): Agency for Healthcare Research and Quality2015 Contract No.: Technical Briefs, No. 18.Google Scholar
- 32.Bureau of Labor Statistics. Databases, Tables & Calculators by Subject. United States Department of Labor. https://www.bls.gov/data/#prices. Accessed April 19 2017.
- 34.Foundation P. Adult needs and strengths assessment. Chicago: IL; 1999.Google Scholar
- 36.Shen Y. Applying the 3M all patient refined diagnosis related groups grouper to measure inpatient severity in the VA. Med Care. 2003:II103–I10.Google Scholar
- 37.Habermeyer B, De Gennaro H, Frizi RC, Roser P, Stulz N. Factors associated with length of stay in a Swiss mental hospital. Psychiatry Q. 2018:1–8.Google Scholar
- 38.Wooldridge J. Introductory econometrics: a modern approach Mason, OH: Thomson Southwestern; 2003.Google Scholar
- 41.Halvorsen R, Palmquist R. The interpretation of dummy variables in semilogarithmic equations. Am Econ Rev. 1980;70(3):474–5.Google Scholar
- 42.James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8). JAMA. 2014;311(5):507–20. https://doi.org/10.1001/jama.2013.284427.CrossRefPubMedGoogle Scholar
- 43.Atkinson MJ, Zibin S. Evaluative review of quality of life instruments. Quality of life measurement among persons with chronic mental illness: a critique of measures and methods. Vol April 17. Systems for Health Directorate, Health Promotion and Programs Branch, Health Canada: Calgary, Alberta, Canada; 1996.Google Scholar
- 44.White C, Frimpong E, Huz S, Ronsani A, Radigan M. Effects of the personalized recovery oriented services (PROS) program on hospitalizations. Psychiatry Q. 2018:1–11.Google Scholar
- 45.Mauer B. Behavioral health/primary care integration and the person-centered healthcare home. Washington, DC: National Council for Community Behavioral Healthcare; 2009.Google Scholar