Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness
Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality, and use of high-cost healthcare services including hospitalizations and emergency department visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study assessed whether there was a predictive relationship between integrated healthcare clinic enrollment and inpatient and emergency department utilization for consumers with SMI when controlling for demographic characteristics and disease severity. While findings indicated no statistically significant impact of integrated care clinic enrollment on utilization, the sample had lower levels of utilization than would have been expected. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.
KeywordsIntegrated care Serious mental illness Physical health Utilization
- De Hert, M., Correll, C. U., Bobes, J., Cetkovic-Bakmas, M., Cohen, D., Asai, I., … Leucht, S. (2011). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry, 10(1), 52–77. https://doi.org/10.1002/j.2051-5545.2011.tb00014.x.CrossRefGoogle Scholar
- Druss, B. G., von Esenwein, S. A., Compton, M. T., Rask, K. J., Zhao, L., & Parker, R. M. (2009). A randomized trial of medical care management for community mental health settings: The Primary Care Access, Referral, and Evaluation (PCARE) study. American Journal of Psychiatry, 167(2), 151–159. https://doi.org/10.1176/appi.ajp.2009.09050691.CrossRefPubMedGoogle Scholar
- Druss, B. G., von Esenwein, S. A., Glick, G. E., Deubler, E., Lally, C., Ward, M. C., & Rask, K. J. (2016). Randomized trial of an integrated behavioral health home: The Health Outcomes Management and Evaluation (HOME) study. American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2016.16050507.CrossRefPubMedGoogle Scholar
- Ettner, S. L., Frank, R. G., Mark, T., & Smith, M. W. (2000). Risk adjustment of capitation payments to behavioral health care carve-outs: How well do existing methodologies account for psychiatric disability? Health Care Management Science, 3(2), 159–169. https://doi.org/10.1023/A:1019033105715.CrossRefPubMedGoogle Scholar
- Ettner, S. L., Frank, R. G., McGuire, T. G., Newhouse, J. P., & Notman, E. H. (1998). Risk adjustment of mental health and substance abuse payments. Inquiry, 35(2), 223–239. Retrieved from http://www.jstor.org/stable/29772757.
- Field, A. (2013). Discovering statistics using IBM SPSS Statistics, 4th ed. Thousand Oaks, CA: SAGE.Google Scholar
- Fitch, K., Iwasaki, K., & Villa, K. F. (2014). Resource utilization and cost in a commercially insured population with schizophrenia. American Health and Drug Benefits, 7(1), 18–26. Retrieved from http://www.AHDBonline.com.
- Gilmer, T. P., Henwood, B. F., Goode, M., Sarkin, A. J., & Innes-Gomberg, D. (2016). Implementation of integrated health homes and health outcomes for persons with serious mental illness in Los Angeles County. Psychiatric Services, 67(10), 1062–1067. https://doi.org/10.1176/appi.ps.201500092.CrossRefPubMedPubMedCentralGoogle Scholar
- Goulet, J. L., Erdos, J., Kancir, S., Levin, F. L., Wright, S. M., Daniels, S. M., … Justice, A. C. (2007). Measuring performance directly using the Veterans Health Administration electronic medical record. Medical Care, 45(1), 73–79. https://doi.org/10.1097/01.mlr.0000244510.09001.e5.CrossRefGoogle Scholar
- Heath, B., Romero, W., P., & Reynolds, K. (2013). A standard framework for levels of integrated healthcare. Washington, D.C.: SAMHSA-HRSA Center for Integrated Health Solutions. Retrieved from http://www.integration.samhsa.gov/resource/ standard-framework-for-levels-of-integrated-healthcare.
- Heslin, K. C., & Weiss, A. J. (2015). Statistical Brief No. Statistical Brief #189. In Hospital readmissions involving psychiatric disorders, 2012. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
- Jones, D. R., Macias, C., Barreira, P. J., Fisher, W. H., Hargreaves, W. A., & Harding, C. M. (2004). Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatric Services, 55(11), 1250–1257. https://doi.org/10.1176/appi.ps.55.11.1250.CrossRefPubMedGoogle Scholar
- Kilbourne, A. M., Biswas, K., Pirraglia, P. A., Sajatovic, M., Williford, W. O., & Bauer, M. S. (2009). Is the collaborative chronic care model effective for patients with bipolar disorder and co-occurring conditions? Journal of Affective Disorders, 112(1–3), 256–261. https://doi.org/10.1016/j.jad.2008.04.010.CrossRefPubMedGoogle Scholar
- Kilbourne, A. M., Lai, Z., Bowersox, N., Pirraglia, P., & Bauer, M. S. (2011). Does colocated care improve access to cardiometabolic screening for patients with serious mental illness? General Hospital Psychiatry, 33, 634–636. https://doi.org/10.1016/j.genhosppsych.2011.07.003.CrossRefPubMedPubMedCentralGoogle Scholar
- Krupski, A., West, I. I., Scharf, D. M., Hopfenbeck, J., Andrus, G., Joesch, J. M., & Snowden, M. (2016). Integrating primary care into community mental health centers: impact on utilization and costs of health care. Psychiatric Services, 67, 1233–1239. https://doi.org/10.1176/appi.ps.201500424.CrossRefPubMedGoogle Scholar
- Laerd Statistics. (2015a). Multiple regression using SPSS Statistics. Statistical tutorials and software guides. Retrieved from https://statistics.laerd.com/.
- Laerd Statistics. (2015b). Poisson regression using SPSS Statistics. Statistical tutorials and software guides. Retrieved from https://statistics.laerd.com/.
- McGinty, E. E., Baller, J., Azrin, S. T., Juliano-Bult, D., & Daumit, G. L. (2016). Interventions to address medical conditions and health-risk behaviors among persons with serious mental illness: A comprehensive review. Schizophrenia Bulletin, 42(1), 96–124. https://doi.org/10.1093/schbul/sbv101.CrossRefPubMedGoogle Scholar
- Minassian, A., Vilke, G. M., & Wilson, M. P. (2013). Frequent emergency department visits are more prevalent in psychiatric, alcohol abuse, and dual diagnosis conditions than in chronic viral illnesses such as hepatitis and human immunodeficiency virus. Journal of Emergency Medicine, 45(4), 520–525. https://doi.org/10.1016/j.jemermed.2013.05.007.CrossRefPubMedGoogle Scholar
- Nussbaum, E. M., Elsadat, S., & Khago, A. H. (2008). Best practices in analyzing count data: Poisson regression. In J. Osborne (Ed.), Best practices in quantitative methods (pp. 306–323). Thousand Oaks, CA: SAGE. Retrieved from http://jwosborne.com/bp_ch21.html.
- Oster, A., & Bindman, A. B. (2003). Emergency department visits for ambulatory care sensitive conditions: Insights into preventable hospitalizations. Medical Care, 41(2), 198–207. https://doi.org/10.1097/01.mlr.0000045021.70297.9f.CrossRefPubMedGoogle Scholar
- Pirraglia, P. A., Kilbourne, A. M., Lai, Z., Friedmann, P. D., & O’Toole, T. P. (2011). Colocated general medical care and preventable hospital admissions for veterans with serious mental illness. Psychiatric Services, 62(5), 554–557. https://doi.org/10.1176/appi.ps.62.5.554.CrossRefPubMedGoogle Scholar
- Pirraglia, P. A., Rowland, E., Wu, W.-C., Friedmann, P. D., O’Toole, T. P., Cohen, L. B., & Taviera, T. H. (2012). Benefits of a primary care clinic collocated and integrated in a mental health setting for veterans with serious mental illness. Preventing Chronic Disease, 9, E51. . https://doi.org/10.5888/pcd9.110113.CrossRefPubMedPubMedCentralGoogle Scholar
- Schaps, M., & Post, S. (2015). Best practices in behavioral–physical health integration. Chicago, IL: Health and Medicine Policy Working Group. Retrieved from hmprg.org.
- Solberg, L. I., Crain, A. L., Jaeckels, N., Ohnsorg, K. A., Margolis, K. L., Beck, A., … Van de Ven, A. H. (2013). The DIAMOND initiative: Implementing collaborative care for depression in 75 primary care clinics. Implementation Science, 8, 135. https://doi.org/10.1186/1748-5908-8-135.
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2013). Results from the 2012 National Survey on Drug Use and Health: Mental health findings (NSDUH Series H-47 No. SMA 13-4805). Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2014, December 19). Primary and behavioral health care integration. Retrieved July 30, 2015, from http://www.samhsa.gov/grants/grant-announcements/sm-15-005.