CRANIUM: A quasi-experimental study to improve metabolic screening and HIV testing in community mental health clinics compared to usual care

Abstract

Background Individuals with serious mental illness often do not receive guideline-concordant metabolic screening and human immunodeficiency virus (HIV) testing, contributing to increased morbidity and premature mortality. This study evaluates the effectiveness of CRANIUM (Cardiometabolic Risk Assessment and treatment through a Novel Integration model for Underserved populations with Mental illness), an intervention to increase metabolic screening and HIV testing among patients with serious mental illness in a community mental health clinic compared to usual care. Methods The study used a quasi-experimental design, implementing the intervention at one community mental health clinic (n = 536 patients) compared to usual care (n = 4,847 patients) in a large urban behavioural health system. Psychiatrists received training in preventive health screening and had access to a primary care consultant, screening and treatment algorithms, patient registries, and a peer support specialist. Outcomes were screening rates of A1c, lipid, and HIV testing post-intervention compared to baseline. Results In the intervention group, there was a statistically significant increase in lipid screening rates from 19.2–25.6% (P = .001) and increase in HIV testing rates from 1.3–15.9% (P < .001). The A1c testing rate increase in the intervention group from 23.7–28.9% was not statistically significant (P = .09). There were no significant changes in screening rates for A1c, lipid, or HIV testing in the usual care group. Conclusions This low-cost, reverse integrated care model targeting community psychiatrist practices had modest effects on increasing preventive care screenings, with the biggest effect seen for HIV testing rates. Additional incentives and structural supports may be needed to further promote screening practices for individuals with serious mental illness.