Mental Health Recovery in the Patient Centered Medical Home

University Of California, San Diego, La Jolla CA

Investigators

Linked publications, trials & patents

Abstract

DESCRIPTION (provided by applicant): The patient-centered medical home (PCMH) has been discussed extensively as a delivery system innovation for improving the current United States health care system. A consensus exists among providers, payers, and policymakers that the current primary care system rewards quantity at the sacrifice of high quality care (Bitton, Martin and Landon, 2010). As a result, the United States is falling behind in comparison to other countries in areas such as amenable mortality and ranks poorly on access and safety (Barr, 2008). Following a 2001 report of the Institute of Medicine calling for a commitment to improve the delivery of health care in the United States, the patient-centered medical home (PCMH) has been discussed extensively as a delivery system innovation for facilitating these improvements (Barr, 2008; Bolin, Gamm, Vest, et al., 2011, Davis, Schoenbaum, and Audet, 2005). Despite these claims, a healthcare delivery system that fails to address mental health will be incomplete and less effective (DeGruy and Etz, 2010). As a result, the assessment of the effectiveness of the PCMH in improving the health of its participants must include an assessment of participants' mental health. The San Diego County Physical Health Integration Project (PHIP) aims to create a PCMH for individuals with severe mental illness. The PHIP transitions clients with severe mental illness from County mental health (MH) treatment programs to a primary care medical home for medication monitoring, chronic disease management education and counseling, and attention to physical health care needs (County of San Diego Health and Human Services Agency, 2009). This proposed study will examine the impact of moving from a County outpatient MH clinic to a PCMH on recovery and service utilization. Using propensity score analysis, a methodologically rigorous statistical technique used in the absence of randomization, this study will assess the impact of the PCMH on recovery and service utilization by comparing PCMH participants to similar clients receiving service as usual (SAU) in County outpatient MH clinics. The proposed study will use the County's large administrative data set to examine the differences in treatment service utilization of the PCMH in comparison to County outpatient MH clinics, and will examine whether treatment service utilization impacts recovery as assessed by reliable and valid standardized instruments. This proposed research plan is an excellent fit with NIMH's third strategic plan objective 3.3 and fourth strategic plan objective 4.1. Evaluation of th effects of the PCMH, a novel model of implementing health care proposed to increase access and improve quality of services, on participants' mental health recovery from the perspectives of both the providers and the participants will provide insight into the effectiveness of this promising treatment from the initial stages of its development within a diverse, underserved population. With appropriate dissemination techniques, the insight gained from this research study can guide future treatment efforts.