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Sandahl M, Lassen AT, Stenager E, Østervang C. Pathways and transitions for patients admitted to an emergency department after self-harming events. Int J Ment Health Nurs 2024. [PMID: 38500171 DOI: 10.1111/inm.13314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/06/2024] [Accepted: 02/16/2024] [Indexed: 03/20/2024]
Abstract
The frequency of people presented in emergency departments (EDs) after self-harming events is increasing. Previous studies have shown that the complexity of the disorders of patients admitted to the ED after self-harming events can be overwhelming for ED healthcare professionals (HCPs) to handle. The objective of this study was to observe and investigate the pathways for patients admitted to the ED after self-harming events to either transition or discharge. Participant observation and interviews were selected as the methods to generate insight into the pathways of patients admitted to the ED after self-harming events. The data were analysed using interpretative phenomenological analysis. A sample size of 20 patients was analysed, and a total of 213 h of observation took place during the data collection. Three main themes appeared: (1) patients' mental stress versus high expectations, (2) uncertainty about how to address the self-harming event and (3) a system of chaos. Patients admitted to the ED after self-harming events struggle with difficult mental stress. Despite this, they face high expectations that they will fit in and cooperate in the ED. The healthcare system is organised with unclear responsibilities and without systematic ways to care for self-harm patients and so provides chaotic patient pathways. There is a need for improved cross-sectional competencies, mutual agreements and systematic communication for discharge, transitions and follow-up care between those involved in the patient's pathway and care.
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Affiliation(s)
- Malene Sandahl
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Mental Health Research Unit, Children and Adult Psychiatry, Region of South Denmark, Aabenraa, Denmark
- Department of Regional Health Services, University of Southern Denmark, Odense, Denmark
| | - Christina Østervang
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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2
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Mao W, Shalaby R, Agyapong VIO. Interventions to Reduce Repeat Presentations to Hospital Emergency Departments for Mental Health Concerns: A Scoping Review of the Literature. Healthcare (Basel) 2023; 11:healthcare11081161. [PMID: 37107995 PMCID: PMC10138571 DOI: 10.3390/healthcare11081161] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The number of readmissions to the emergency department (ED) for mental health services each year is significant, which increases healthcare costs and negatively affects the morale and quality of life of patients and their families. OBJECT This scoping review aimed to establish a better understanding of interventions that have been implemented to reduce psychiatric patient readmission and ED use within the ED, to identify areas for improvement, and therefore to assist in the development of more effective actions in the future. METHOD The scoping review was conducted on several bibliographic databases to identify relevant studies. Two researchers independently screened and reviewed titles, abstracts, and full-text articles that met the inclusion criteria. Using Covidence software, 26 out of 6951 studies were eligible for inclusion in this scoping review based on the PRISMA checklist. Data were extracted, collated, summarized, presented, and discussed. RESULT This review identified 26 studies which examined interventions aimed to reduce ED visits, such as the High Alert Program (HAP), the Patient-Centered Medical Home (PCMH), the Primary Behavioral Health Care Integration (PBHCI), and the Collaborative Care (CC) Program, etc. Twenty-three of the studies were conducted in North America, while the rest were conducted in Europe and Australia. A total of 16 studies examined interventions directed to any mental health conditions, while the rest addressed specific health conditions, such as substance use disorders, schizophrenia, anxiety, depression. Interventions involved comprehensive and multidisciplinary services, incorporation of evidence-based behavioral and pharmacological strategies, and emphasized the case management that was found to be effective. Additionally, there was a marked consideration for diverse mental health groups, such as those with substance use disorder and of young age. Most interventions showed a positive effect on reducing psychiatric ED visits. CONCLUSION Various initiatives have been implemented worldwide to reduce the number of emergency department visits and the associated burden on healthcare systems. This review highlights the greater need for developing more accessible interventions, as well as setting up a comprehensive community health care system aiming to reduce frequent ED presentations.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans, Memorial Lane, 8th Floor Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS B3H 2E2, Canada
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Newton H, Busch SH, Brunette MF, Maust DT, O'Malley AJ, Meara E. Innovations in Care Delivery for Patients With Serious Mental Illness Among Accountable Care Organizations. Psychiatr Serv 2022; 73:889-896. [PMID: 35378992 PMCID: PMC9349464 DOI: 10.1176/appi.ps.202000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined whether and how organizations participating in accountable care organization (ACO) contracts integrate primary care and treatment for patients with serious mental illness. METHODS This study used responses to the 2017–2018 National Survey of ACOs (55% response rate) to measure ACO-reported use of three integrated care strategies: care manager to address physical health treatment coordination or nonmedical needs (e.g., job support and housing), patient registries to track physical health conditions, and primary care clinician colocated in a specialty mental health setting. Logistic regression was used to determine associations between ACO characteristics and strategy use. RESULTS Of 399 respondents who answered questions on integration, 303 (76%) reported using at least one integrated care strategy in at least one location. Use of care managers (defined by the respondent) was most common (N=281, 70%), followed by use of a patient registry (N=146, 37%) and colocation of a primary care clinician in a specialty mental health setting (N=118, 30%). Respondents reporting that their largest Medicaid contract or largest commercial contract included quality measures specific to serious mental illness (e.g., antipsychotic adherence) were more likely to use each integrated care delivery strategy. Self-reported use of three collaborative care strategies (care management, patient registry, or mental health consulting clinician) for treatment of depression or anxiety was associated with use of integrated primary care and treatment for serious mental illness. CONCLUSIONS In a national survey of ACOs, few respondents reported using either patient registries or primary care colocation to integrate primary care and treatment for serious mental illness.
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Affiliation(s)
- Helen Newton
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Newton, Busch); Department of Psychiatry (Brunette), Department of Biomedical Data Science (O'Malley), and Dartmouth Institute for Health Policy and Clinical Practice (O'Malley), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Bureau of Mental Health, New Hampshire Department of Health and Human Services, Concord (Brunette); Department of Psychiatry, University of Michigan School of Medicine, and Department of Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (Maust); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - Susan H Busch
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Newton, Busch); Department of Psychiatry (Brunette), Department of Biomedical Data Science (O'Malley), and Dartmouth Institute for Health Policy and Clinical Practice (O'Malley), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Bureau of Mental Health, New Hampshire Department of Health and Human Services, Concord (Brunette); Department of Psychiatry, University of Michigan School of Medicine, and Department of Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (Maust); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - Mary F Brunette
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Newton, Busch); Department of Psychiatry (Brunette), Department of Biomedical Data Science (O'Malley), and Dartmouth Institute for Health Policy and Clinical Practice (O'Malley), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Bureau of Mental Health, New Hampshire Department of Health and Human Services, Concord (Brunette); Department of Psychiatry, University of Michigan School of Medicine, and Department of Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (Maust); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - Donovan T Maust
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Newton, Busch); Department of Psychiatry (Brunette), Department of Biomedical Data Science (O'Malley), and Dartmouth Institute for Health Policy and Clinical Practice (O'Malley), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Bureau of Mental Health, New Hampshire Department of Health and Human Services, Concord (Brunette); Department of Psychiatry, University of Michigan School of Medicine, and Department of Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (Maust); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - A James O'Malley
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Newton, Busch); Department of Psychiatry (Brunette), Department of Biomedical Data Science (O'Malley), and Dartmouth Institute for Health Policy and Clinical Practice (O'Malley), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Bureau of Mental Health, New Hampshire Department of Health and Human Services, Concord (Brunette); Department of Psychiatry, University of Michigan School of Medicine, and Department of Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (Maust); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
| | - Ellen Meara
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut (Newton, Busch); Department of Psychiatry (Brunette), Department of Biomedical Data Science (O'Malley), and Dartmouth Institute for Health Policy and Clinical Practice (O'Malley), Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Bureau of Mental Health, New Hampshire Department of Health and Human Services, Concord (Brunette); Department of Psychiatry, University of Michigan School of Medicine, and Department of Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan (Maust); Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (Meara)
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4
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Sepassi A, Bounthavong M, Singh RF, Heyman M, Beizai K, Watanabe JH. Risk of Negative Health Outcomes and High Costs for People With Diabetes and Unmet Psychological Needs in the United States. Diabetes Spectr 2022; 35:207-215. [PMID: 35668883 PMCID: PMC9160558 DOI: 10.2337/ds21-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Measuring the population-level relationship between compromised mental health and diabetes care remains an important goal for clinicians and health care decision-makers. We evaluated the impact of self-reported unmet psychological need on health care resource utilization and total health care expenditure in people with type 2 diabetes. Patients who reported unmet psychological needs were more likely than those who did not to incur a higher annual medical expenditure, have greater resource utilization, and have a higher risk of all-cause mortality.
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Affiliation(s)
- Aryana Sepassi
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
- Corresponding author: Aryana Sepassi,
| | - Mark Bounthavong
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
- VA Health Economics Resource Center, Menlo Park, CA
| | - Renu F. Singh
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA
- University of California San Diego Health System, University of California, La Jolla, CA
| | - Mark Heyman
- Center for Diabetes & Mental Health, San Diego, CA
| | - Kristin Beizai
- Department of Psychiatry, University of California San Diego, La Jolla, CA
- VA San Diego Healthcare System, San Diego, CA
| | - Jonathan H. Watanabe
- Department of Clinical Pharmacy Practice, University of California, Irvine, School of Pharmacy & Pharmaceutical Sciences, Irvine, CA
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Frimpong EY, Ferdousi W, Rowan GA, Radigan M. Impact of the 1115 behavioral health Medicaid waiver on adult Medicaid beneficiaries in New York State. Health Serv Res 2021; 56:677-690. [PMID: 33876432 DOI: 10.1111/1475-6773.13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the impact of the Health and Recovery Plan (HARP), a capitated special needs Medicaid managed care product that fully integrates physical and behavioral health delivery systems in New York State. DATA SOURCES 2013-2019 claims and encounters data on continuously enrolled individuals from the New York State Medicaid data system. STUDY DESIGN We used a difference-in-difference approach with inverse probability of exposure weights to compare service use outcomes in individuals enrolled in the HARP versus HARP eligible comparison group in two regions, New York City (NYC) pre- (2013-2015) versus post- (2016-2018) intervention periods, and rest of the state (ROS) pre- (2014-2016) versus post- (2017-2019) intervention periods. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS HARPs were associated with a relative decrease in all-cause (RR = 0.78, 95% CI 0.68-0.90), behavioral health-related (RR = 0.76, 95% CI 0.60-0.96), and nonbehavioral-related (RR = 0.87, 95% CI 0.78-0.97) stays in the NYC region. In the ROS region, HARPs were associated with a relative decrease in all-cause (RR = 0.87, 95% CI 0.80-0.94) and behavioral health-related (RR = 0.80, 95% CI 0.70-0.91) stays. Regarding outpatient visits, the HARPs benefit package were associated with a relative increase in behavioral health (RR = 1.21, 95% CI 1.13-1.28) and nonbehavioral health (RR = 1.08, 95% CI 1.01-1.15) clinic visits in the NYC region. In the ROS region, the HARPs were associated with relative increases in behavioral health (RR = 1.47, 95% CI 1.32-1.64) and nonbehavioral health (RR = 1.17, 95% CI 1.11-1.25) clinic visits. CONCLUSIONS Compared to patients with similar clinical needs, HARPs were associated with a relative increase in services used and led to a better engagement in the HARPs group regardless of the overall decline in services used pre- to postperiod.
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Affiliation(s)
- Eric Y Frimpong
- New York State Office of Mental Health, Albany, New York, USA
| | - Wahida Ferdousi
- New York State Office of Mental Health, Albany, New York, USA
| | - Grace A Rowan
- New York State Office of Mental Health, Albany, New York, USA
| | - Marleen Radigan
- New York State Office of Mental Health, Albany, New York, USA
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6
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Breslau J, Leckman-Westin E, Han B, Guarasi D, Yu H, Horvitz-Lennon M, Pritam R, Finnerty M. Providing Health Physicals and/or Health Monitoring Services in Mental Health Clinics: Impact on Laboratory Screening and Monitoring for High Risk Populations. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:279-289. [PMID: 32705374 PMCID: PMC7854854 DOI: 10.1007/s10488-020-01071-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Providing physical health care in specialty mental health clinics is a promising approach to improving the health status of adults with serious mental illness, but most programs examined in prior studies are not financially sustainable. This study assessed the impact on quality of care of a low-cost program implemented in New York State that allowed mental health clinics to be reimbursed by Medicaid for provision of health monitoring and health physicals (HM/HP). Medicaid claims data were analyzed with generalized linear multilevel models to examine change over time in quality of physical health care associated with HM/HP services. Recipients of HM/HP services were compared to control clinic patients [Per protocol (PP)] and with non-recipients of HM/HP services from both intervention and control clinics [As-Treated (AT)]. HM/HP clinic patients, regardless of receipt of HM/HP services, were compared with control clinic patients [Intent-to-Treat (ITT)]. Analyses were conducted with adjustment for patient demographic and clinical characteristics and prior year service use. The PP and AT analyses found significant improvement in measure of blood glucose screening for patients on antipsychotic medication and HbA1C testing for patients with diabetes (AOR range 1.26-1.33) and the AT analysis found significant improvement in cholesterol screening for patients on antipsychotic medication (AOR 1.24). However, ITT analysis found no significant changes in quality of care in HM/HP clinic caseloads relative to control clinics. The low-cost HM/HP program has the potential to benefit patients who receive supported services, but its impact is limited by remaining barriers to service implementation.
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Affiliation(s)
- Joshua Breslau
- RAND Corporation, 4570 Fifth Avenue, Suite, Pittsburgh, PA, 15213, USA.
| | | | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Diana Guarasi
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | - Hao Yu
- Harvard Pilgrim Health Care Institute, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | | | - Riti Pritam
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | - Molly Finnerty
- New York University, Langone Medical Center, New York, NY, 10016, USA
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7
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Abstract
Pediatricians are increasingly asked to address the mental health care needs of their patients, despite lack of formal mental health training. Pediatricians who wish to expand their scope of practice to include mental health care may benefit from didactic training as well as ongoing consultative or collaborative relationships with mental health specialists. Consultative and collaborative relationships between mental health and primary care have evolved in various models across the country. We outline models of mental health consultation and collaboration, address some considerations for pediatricians prior to adopting a model, and list key collaborative care resources. [Pediatr Ann. 2020;49(10):e416-e420.].
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8
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Fortuna KL, DiMilia PR, Lohman MC, Cotton BP, Cummings JR, Bartels SJ, Batsis JA, Pratt SI. Systematic Review of the Impact of Behavioral Health Homes on Cardiometabolic Risk Factors for Adults With Serious Mental Illness. Psychiatr Serv 2020; 71:57-74. [PMID: 31500547 PMCID: PMC6939136 DOI: 10.1176/appi.ps.201800563] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This systematic review examined the impact of health homes on cardiometabolic risk among adults with serious mental illness. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses procedures were used to conduct the systematic review. Databases were searched for peer-reviewed articles published between 1946 and August 2018 that compared health homes with a control condition (e.g., usual care and secondary data analyses using matched samples). Participants, interventions, comparisons, outcomes, and study design criteria were used to assess study eligibility. Studies were assessed for methodological quality by using the Quality Assessment of Before and After Studies With No Control Group and the Quality Assessment of Controlled Intervention Studies. RESULTS Eighteen studies (i.e., 11 observational studies, four quasi-experimental studies, and three randomized controlled trials) reported on 17 health homes. Most studies reported increases in receipt of screening for cardiometabolic risk factors and service use. There was a modest reduction in selected cardiometabolic risk factors among people with serious mental illness, but clinical outcomes varied widely among studies. CONCLUSIONS Improvement in cardiometabolic risk factors varied across the studies, and the clinical significance of these reductions was not clear. Peer support and self-management training may represent strategies to improve cardiometabolic risk factors. Colocation of services may not be enough to significantly affect cardiometabolic risk factors. Health homes that include standardized screening, peer support and self-management training, and intervention components that target interdependent risk factors may have a greater impact on clinical outcomes.
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Affiliation(s)
- Karen L. Fortuna
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Peter R. DiMilia
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Matthew C. Lohman
- Arnold School of Public Health, University of South Carolina, Columbia, SC
| | | | - Janet R. Cummings
- Department of Health Policy and Management, Emory University, Atlanta, GA
| | - Stephen J. Bartels
- The Mongan Institute at Massachusetts General Hospital, Harvard University, Boston, MA
| | - John A. Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
- The Dartmouth Institute at the Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Sarah I. Pratt
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
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9
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Stone EM, Daumit GL, Kennedy-Hendricks A, McGinty EE. The Policy Ecology of Behavioral Health Homes: Case Study of Maryland's Medicaid Health Home Program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:60-72. [PMID: 31506860 PMCID: PMC7040852 DOI: 10.1007/s10488-019-00973-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Behavioral health homes, shown to improve receipt of evidence-based medical services among people with serious mental illness in randomized clinical trials, have had limited results in real-world settings; nonetheless, these programs are spreading rapidly. To date, no studies have considered what set of policies is needed to support effective implementation of these programs. As a first step toward identifying an optimal set of policies to support behavioral health home implementation, we use the policy ecology framework to map the policies surrounding Maryland's Medicaid behavioral health home program. Results suggest that existing policies fail to address important implementation barriers.
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Affiliation(s)
- Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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10
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Improving Outcomes of Care for HRSA-Funded Health Center Patients Who Have Mental Health Conditions and Substance Use Disorders. J Behav Health Serv Res 2019; 47:168-188. [PMID: 31214934 DOI: 10.1007/s11414-019-09665-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The rising prevalence of mental health conditions and substance use disorders (MH/SUD) underscores the important role of health centers (HCs) in caring for low-income and uninsured MH/SUD patients. This study used the 2014 Health Center Patient Survey and 2014 Uniform Data System to determine the independent association between delivery of MH/SUD integration and related interventions to patients that reported a MH/SUD condition (n=2714) with the number of HC visits, emergency department (ED) visits, and hospitalizations last year. Results showed that health education was associated with fewer predicted ED visits (1.8 vs. 2.3) and lower likelihood of hospitalizations (16% vs. 24%) among MH patients. Medical enabling services was associated with lower rates of ED visits (0.3 vs.1.9) and hospitalizations (< 1% vs. 13%) among SUD patients. The results indicate the utility of integration and related intervention services in primary care settings to improve service use and reduce ED and hospitalization among MH/SUD patients.
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Murphy KA, Daumit GL, Stone E, McGinty EE. Physical health outcomes and implementation of behavioural health homes: a comprehensive review. Int Rev Psychiatry 2018; 30:224-241. [PMID: 30822169 PMCID: PMC6499693 DOI: 10.1080/09540261.2018.1555153] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
People with serious mental illness (SMI) have mortality rates 2-3-times higher than the general population, mostly driven by physical health conditions. Behavioural health homes (BHHs) integrate primary care into specialty mental healthcare settings with the goal of improving management of physical health conditions among people with SMI. Implementation and evaluation of BHH models is increasing in the US. This comprehensive review summarized the available evidence on the effects of BHHs on physical healthcare delivery and outcomes and identified perceived barriers and facilitators that have arisen during implementation to-date. This review found 11 studies reporting outcomes data on utilization, screening/monitoring, health promotion, patient-reported outcomes, physical health and/or costs of BHHs. The results of the review suggest that BHHs have resulted in improved primary care access and screening and monitoring for cardiovascular-related conditions among consumers with SMI. No significant effect of BHHs was reported for outcomes on diabetes control, weight management, or smoking cessation. Overall, the physical health outcomes data is limited and mixed, and implementation of BHHs is variable.
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Affiliation(s)
- Karly A. Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, United States
| | - Gail L. Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, United States,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Elizabeth Stone
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, United States
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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12
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Dalcin AT, Jerome GJ, Appel LJ, Dickerson FB, Wang NY, Miller ER, Young DR, Charleston JB, Gennusa JV, Goldsholl S, Heller A, Evins AE, Cather C, McGinty EE, Crum RM, Daumit GL. Need for Cardiovascular Risk Reduction in Persons With Serious Mental Illness: Design of a Comprehensive Intervention. Front Psychiatry 2018; 9:786. [PMID: 30800079 PMCID: PMC6375886 DOI: 10.3389/fpsyt.2018.00786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/31/2018] [Indexed: 01/30/2023] Open
Abstract
Persons with serious mental illness (SMI) comprise a high-risk group for cardiovascular disease (CVD)-related mortality with rates at least twice those of the overall US. Potentially modifiable CVD risk behaviors (tobacco smoking, obesity, physical inactivity, unhealthy diet) and risk factors (hypertension, diabetes, dyslipidemia) are all markedly elevated in persons with SMI. Evaluations of programs implementing integrated medical care into specialty mental health settings have not shown meaningful effects on CVD risk factor reduction. Rigorously tested, innovative interventions are needed to address the large burden of CVD risk in populations with SMI. In this article, we describe the design of a comprehensive 18-month intervention to decrease CVD risk that we are studying in a randomized clinical trial in a community mental health organization with psychiatric rehabilitation programs. The individual-level intervention incorporated health behavior coaching and care coordination/care management to address all seven CVD risk behaviors and risk factors, and is delivered by a health coach and nurse. If successful, the intervention could be adopted within current integrated care models and significantly improve the physical health of persons with SMI.
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Affiliation(s)
- Arlene T Dalcin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Baltimore, MD, United States
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Edgar R Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Deborah R Young
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeanne B Charleston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joseph V Gennusa
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ann Heller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - A Eden Evins
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Corinne Cather
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Emma E McGinty
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Rosa M Crum
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Gail L Daumit
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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