Abstract
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.
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References
Anderson, G., & Knickman, J. R. (2001). Changing the chronic care system to meet people’s needs. Health Affairs, 20(6), 146–160. https://doi.org/10.1377/hlthaff.20.6.146.
Barry, C. L., & Huskamp, H. A. (2011). Moving beyond parity—mental health and addiction care under the ACA. New England Journal of Medicine, 365(11), 973–975. https://doi.org/10.1056/NEJMp1108649.
Cahoon, E. K., McGinty, E. E., Ford, D. E., & Daumit, G. L. (2013). Schizophrenia and potentially preventable hospitalizations in the United States: A retrospective cross-sectional study. BMC Psychiatry, 13, 37. https://doi.org/10.1186/1471-244X-13-37.
Charlson, M., Wells, M. T., Ullman, R., King, F., & Shmukler, C. (2014). The Charlson Comorbidity Index can be used prospectively to identify patients who will incur high future costs. PLoS ONE, 9(12), e112479. https://doi.org/10.1371/journal.pone.0112479.
D’Hoore, W., Bouckaert, A., & Tilquin, C. (1996). Practical considerations on the use of the Charlson Comorbidity Index with administrative data bases. Journal of Clinical Epidemiology, 49(12), 1429–1433. https://doi.org/10.1016/S0895-4356(96)00271-5.
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.
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613–619. https://doi.org/10.1016/0895-4356(92)90133-8.
Druss, B. G., & Mauer, B. J. (2010). Health care reform and care at the behavioral health–primary care interface. Psychiatric Services, 61(11), 1087–1092. https://doi.org/10.1176/appi.ps.61.11.1087.
Druss, B. G., Rohrbaugh, R. M., Levinson, C. M., & Rosenheck, R. A. (2001). Integrated medical care for patients with serious psychiatric illness: A randomized trial. Archives of General Psychiatry, 58(9), 861–868. https://doi.org/10.1001/archpsyc.58.9.861.
Druss, B. G., Rosenheck, R. A., Desai, M. M., & Perlin, J. B. (2002). Quality of preventive medical care for patients with mental disorders. Medical Care, 40(2), 129–136. https://doi.org/10.1097/00005650-200202000-00007.
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.
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.
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.
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.
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.
Frank, R. G., & Epstein, A. M. (2014). Factors associated with high levels of spending for younger dually eligible beneficiaries with mental disorders. Health Affairs, 33(6), 1006–1013. https://doi.org/10.1377/hlthaff.2013.0769.
Gerrity, M. (2015). Integrating primary care into behavioral health settings: What works for individuals with serious mental illness. Washington, D.C.: Milbank Memorial Fund. Retrieved from www.milbank.org.
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.
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.
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.
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.
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.
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.
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.
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/.
Li, Y., Glance, L. G., Cai, X., & Mukamel, D. B. (2008). Mental illness and hospitalization for ambulatory care sensitive medical conditions. Medical Care, 46(12), 1249–1256. https://doi.org/10.1097/MLR.0b013e31817e188c.
Manderscheid, R., & Kathol, R. (2014). Fostering sustainable, integrated medical and behavioral health services in medical settings. Annals of Internal Medicine, 160, 61–65. https://doi.org/10.7326/m13-1693.
McCusker, J., Roberge, D., Lévesque, J. F., Ciampi, A., Vadeboncoeur, A., Larouche, D., & Sanche, S. (2010). Emergency department visits and primary care among adults with chronic conditions. Medical Care, 48(11), 972–980. https://doi.org/10.1097/MLR.0b013e3181eaf86d.
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.
McGinty, E. E., & Sridhara, S. (2014). Potentially preventable medical hospitalizations among Maryland residents with mental illness, 2005–2010. Psychiatric Services, 65(7), 951–953. https://doi.org/10.1176/appi.ps.201300323.
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.
Mitchell, A. J., & Lawrence, D. (2011). Revascularisation and mortality rates following acute coronary syndromes in people with severe mental illness: comparative meta-analysis. British Journal of Psychiatry, 198(6), 434–441. https://doi.org/10.1192/bjp.bp.109.076950.
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.
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.
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.
Randall, I., Mohr, D. C., & Maynard, C. (2014). VHA patient-centered medical home associated with lower rate of hospitalizations and specialty care among veterans with posttraumatic stress disorder. Journal for Healthcare Quality. https://doi.org/10.1111/jhq.12092.
Salsberry, P. J., Chipps, E., & Kennedy, C. (2005). Use of general medical services among Medicaid patients with severe and persistent mental illness. Psychiatric Services, 56, 458–462. https://doi.org/10.1176/appi.ps.56.4.458.
Schaps, M., & Post, S. (2015). Best practices in behavioral–physical health integration. Chicago, IL: Health and Medicine Policy Working Group. Retrieved from hmprg.org.
Shanmugam, R. (2007). Poisson distribution. In N. Salkind (Ed.), Encyclopedia of measurement and statistics (Vol. 3, pp. 773–776). Thousand Oaks, CA: SAGE. https://doi.org/10.4135/9781412952644.n350.
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.
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.
Tang, N., Stein, J., Hsia, R. Y., Maselli, J. H., & Gonzales, R. (2010). Trends and characteristics of US emergency department visits, 1997–2007. Journal of the American Medical Association, 304(6), 664–670. https://doi.org/10.1001/jama.2010.1112.
Thiejke, S., Vannoy, S., & Unutzer, J. (2007). Integrating mental health and primary care. Primary Care Clinical Office Practice, 34, 571–592. https://doi.org/10.1016/j.pop.2007.05.007.
Thornicroft, G. (2011). Physical health disparities and mental illness: The scandal of premature mortality. British Journal of Psychiatry, 199, 441–442. https://doi.org/10.1192/bjp.bp.111.092718.
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Waters, H.C., Furukawa, M.F. & Jorissen, S.L. Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness. Community Ment Health J 54, 1101–1108 (2018). https://doi.org/10.1007/s10597-018-0297-x
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DOI: https://doi.org/10.1007/s10597-018-0297-x