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Health Services Research & Development

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2008 HSR&D National Meeting Abstract

National Meeting 2008

3061 — Integrating General Medical Services for Veterans with Serious Mental Illness: What is the Role of Accountability?

Greenwald D (VA Pittsburgh CHERP), Kilbourne AM (VA Ann Arbor HSRD), McCarthy JF (VA Ann Arbor HSRD), Hermann R (VA Boston COLMR), Blow FC (VA Ann Arbor HSRD), Charns MP (VA Boston COLMR), Yano EM (VA GLA HSRD)

Veterans with serious mental illness (SMI) suffer disproportionately from general medical conditions, yet often face barriers to general medical services as they are primarily managed in specialty mental health settings. Providers may only consider themselves accountable for outcomes for the condition in which they specialize; the co-occurring condition may go unnoticed, get referred elsewhere or not attended to at all. The purpose of this study is to determine the extent to which VA mental health (MH) program leaders consider their services accountable for the management of key co-occurring general medical conditions among veterans with SMI, and determine the organizational factors associated with accountability.

The VA MH Program Survey is a national survey on the organization and integration of care for co-occurring conditions. MH program leaders from 108 out of 133 programs (81%) completed the survey in fiscal year 2007. Program leaders were asked to identify whether providers in their MH program as opposed to external general medical (GM) providers were primarily responsible for screening for diabetes and cardiovascular disease (CVD) risk factors (i.e., associated with atypical antipsychotics), Hepatitis C screening, and obesity/weight management for patients with SMI

Of the 108 MH programs, 36% reported they were primarily responsible for diabetes/CVD screening, 10% for Hepatitis C screening, and 12% for obesity/weight management. In contrast, 78% were primarily responsible for psychotropic drug-level monitoring. Nationally, 18%,15%, and 6% of MH leaders received financial bonuses for achieving target levels of diabetes/CVD risk screening, Hepatitis C screening, and obesity/weight management, respectively. After controlling for co-location of general medical providers, staffing, academic affiliation, and size, receiving a financial bonus for CVD risk screening was independently associated with primary accountability for providing CVD screening services (OR= 2.01;p=0.005).

Financial incentives to improve performance on quality measures related to CVD risk assessment may lead to greater perceived accountability and subsequent improved integration of general medical services for veterans with SMI.

Integrated general medical care for veterans with chronic mental illness is essential for improving outcomes and enhancing recovery. Incentives such as bonuses (i.e., pay-for-performance) may encourage integrated care practices for veterans with SMI.

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