The Effectiveness of a Specialized Primary Care Medical Home for Patients with Serious Mental Illness

Young, Alexander S.; Chang, Ernest S.; Cohen, Amy N.; Oberman, Rebecca; Chang, Dennis T; Hamilton, Alison B.; Lindamer, Laurie A.; Sanford, Jesse; Whelan, Fiona

doi:10.1007/s11606-021-07270-x

Cited by 6 publications

(10 citation statements)

References 31 publications

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“…The SMI PACT study's methods have been published previously (Young et al, 2018(Young et al, , 2022. The SMI PACT model was implemented from May 2016 to February 2019 at a large urban VA medical center.…”

Section: Methods Settingmentioning

confidence: 99%

“…The intervention has been described in detail elsewhere (Chang et al, 2019;Young et al, 2018Young et al, , 2022. Briefly, the SMI PACT team consisted of a PCP, RN care manager, consulting psychiatrist, and clerk.…”

Section: Methods Settingmentioning

confidence: 99%

“…The implementation and effectiveness of SMI PACT were studied in a controlled trial, results of which have been previously published (Young et al, 2022). In the analyses presented here, the goal was to qualitatively evaluate patient experience and satisfaction with the integrated SMI PACT model of care in order to strengthen the model and inform dissemination.…”

mentioning

confidence: 99%

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Patient experiences with a primary care medical home tailored for people with serious mental illness.

Bergman,

Chang,

Cohen

et al. 2024

Families, Systems, & Health

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Introduction: People with serious mental illness (SMI) have low rates of primary care (PC) use and die years prematurely, mostly because of medical illnesses such as cardiovascular disease or cancer. To meet the needs of these individuals, a novel, specialized patient-centered medical home with care coordination (“SMI PACT”) was developed and implemented in PC. This study qualitatively examined patients’ experiences with this innovative care model. Method: After implementation of the medical home in 2018, one-on-one semistructured interviews were conducted with 28 patients (32% women, 43% Black, and 25% Hispanic). Interviews were professionally transcribed and coded prior to thematic analysis. Results: Patients overwhelmingly described positive experiences with SMI PACT because of the qualities of interpersonal communication displayed by SMI PACT staff (e.g., nonjudgment, good listening, patience), structural features of the SMI PACT collaborative care model (e.g., frequent follow-up communication), and other unique aspects of the SMI PACT model tailored for SMI, such as easy-to-understand language. For these reasons, most patients expressed a desire to continue care in SMI PACT. Patients also self-reported improved engagement with their healthcare and self-management of diet, exercise, blood pressure, and diabetes control as a result of SMI PACT participation. Discussion: Patients enrolled in a specialized PC medical home identified clinician characteristics and behaviors that informed an overwhelmingly positive impression of the program model. Their experiences can guide dissemination of specialized PC models and integrated services for people with SMI.

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Section: Methods Settingmentioning

confidence: 99%

Section: Methods Settingmentioning

confidence: 99%

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Patient experiences with a primary care medical home tailored for people with serious mental illness.

Bergman,

Chang,

Cohen

et al. 2024

Families, Systems, & Health

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“…The parent study's methods have previously been described elsewhere (Young et al, 2018(Young et al, , 2022. In May 2016, an SMI-PACT team was established at a large urban VA medical center.…”

Section: Setting and Intervention Designmentioning

confidence: 99%

“…When needed, the psychiatrist also counseled on the adjustment of psychiatric medications and whether there was a need for the patient to return to intensive specialty mental health services (Chang et al, 2019). The trial consisted of 331 patients with SMI and demonstrated that an SMI-specialized primary care medical home (i.e., SMI-PACT) resulted in improvements in treatment appropriateness, chronic illness care and care experience, psychotic symptoms, and mental health-related quality of life at 12 months compared to usual care (Young et al, 2022). Additionally, SMI-PACT improved the use of preventive services, including metabolic screenings, as well as chronic illness care and care experience, psychotic symptoms, and mental health-related quality of life.…”

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confidence: 99%

Informing implementation and dissemination of a specialized primary care medical home for patients with serious mental illness: Clinician and administrator perspectives.

Chinchilla,

Greenberg,

Chassman

et al. 2024

Psychological Services

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People with serious mental illness (SMI) have lower rates of use of preventative medical services and higher rates of mortality compared to the general population. Research shows that specialized primary care medical homes improve the health care of patients with SMI and are feasible to implement, safe, and more effective than usual care. However, specialized medical homes remain uncommon and model dissemination limited. As part of a controlled trial assessing an SMI-specialized medical home, we examined clinician and administrator perspectives regarding specialized versus mainstream primary care and identified ways to enhance the scale-up of a specialized primary care model for future dissemination. We conducted semistructured interviews with clinicians and administrators at three sites prior to the implementation of an SMI-specialized primary care medical home (n = 26) and at 1-year follow-up (n = 24); one site implemented the intervention, and two sites served as controls. Interviews captured service design features that affected the quality of care provided; contextual factors that supported or impeded medical home implementation; and knowledge, attitudes, and behaviors regarding the care of patients with SMI. Interviews were transcribed and coded. Clinicians and administrators described SMI-specialized primary care medical homes as advancing care coordination and outcomes for patients with SMI. Stakeholders identified elements of a specialized medical home that they viewed as superior to usual care, including having a holistic picture of patients’ needs and greater care coordination. However, to enable scale-up, efforts are needed to increase staffing on care teams, develop robust clinician onboarding or training, and ensure close coordination with mental health care providers.

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The Characteristics of People with Serious Mental Illness Who are at High Risk for Hospitalization or Death

Young,

Skela,

Siddarth

2024

Community Ment Health J

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The Effectiveness of a Specialized Primary Care Medical Home for Patients with Serious Mental Illness

Cited by 6 publications

References 31 publications

Patient experiences with a primary care medical home tailored for people with serious mental illness.

Patient experiences with a primary care medical home tailored for people with serious mental illness.

Informing implementation and dissemination of a specialized primary care medical home for patients with serious mental illness: Clinician and administrator perspectives.

The Characteristics of People with Serious Mental Illness Who are at High Risk for Hospitalization or Death

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