Community Mental Health Center Integrated Care Outcomes

Abstract

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.

The association between medical comorbidity and psychotherapy processes and outcomes for major depressive disorder in a community mental health setting.

“…Based on the high prevalence of medical disorders found here, and the impact of nervous system disorders on the outcome of treatments for depression, our results may provide some support for medical providers addressing these particular comorbidities if present in the CMHC patient population. Addressing such medical issues through integrated care is worth considering given that studies of integrating medical care into community mental health centers has yielded positive preliminary results for a number of medical conditions (Wells et al, 2018).…”

Understanding perceptions of involving community pharmacy within an integrated care model: a qualitative study

“…Over the past several years, there has been more emphasis on integration within health care [1][2][3][4][5][6][7][8]. In a 2016 World Health Organization report on integrated care, "integration is a coherent set of methods and models on the funding, administrative, organizational, service delivery, and clinical levels designed to create connectivity, alignment and collaboration within and between the cure and care sectors."…”

“Clearly they are in the circle of care, but . . .”: A qualitative study exploring perceptions of personal health information sharing with community pharmacists in an integrated care model

“…There is increasing evidence that integrated care models improve coordination of care, appropriate use of health services and patient outcomes. [1][2][3][4][5][6][7] These models are particularly important for patients who have complex health and social needs and who are cared for by multiple providers. 8,9 In an effort to improve integration of care for persons with complex needs, Ontario's Ministry of Health and Long-Term Care created the Health Links approach to care in 2012.…”