3047 — Quality of General Medical Care for Patients with Serious Mental Illness: Does Co-Location of Services Matter?
Kilbourne AM (VA Ann Arbor HSRD COE), Pirraglia P
(VA Providence REAP), Lai Z
(VA Ann Arbor HSRD COE), Bauer MS
(VA Boston COLMR), Charns MP
(VA Boston COLMR), Greenwald DE
(VA Pittsburgh CHERP), Welsh D
(VA Ann Arbor HSRD COE), McCarthy JF
(VA Ann Arbor HSRD COE), Yano EM
(VA Greater LA COE)
Despite the rapid implementation of integrated mental health services in primary care settings, few studies exist on the availability and quality of integrated medical services for persons with serious mental illness (SMI), who are more likely to be burdened with and die earlier from general medical conditions than the general population. We determined whether Veterans with SMI receiving care in VA mental health programs with integrated (co-located) general medical clinics were more likely to receive adequate quality of medical care than those in programs without co-located medical clinics based on a nationally representative sample.
All VA patients diagnosed with SMI in fiscal year (FY) 2006-2007 who were also part of the VA's External Peer Review Program FY2007 random sample and who received care from VA facilities with organizational data from the SMI Integration Survey (SMII) were included. Conducted in late 2006, SMII was a national survey of organization and integration of VA mental health programs. EPRP included nine chart review-based quality indicators for hypertension control, diabetes (blood sugar, lipid control, foot exam, retinal exam), cancer screening (colorectal, breast), and behavioral medicine (tobacco counseling, alcohol misuse screening).
Out of 224,139 VA patients with SMI, 105,100 (46.9%) received care from 107 sites with complete survey information, and 7,514 (7.1%) were in the EPRP random sample. Ten mental health programs had co-located medical clinics. After adjusting for organizational and patient-level factors, SMI patients from programs with co-located medical providers were more likely to receive diabetes foot exams (OR = 2.22, 95% CI:1.16, 4.38; P = .01), colorectal cancer screening (OR = 1.61, 95% CI:1.15, 2.25, P = .01) or alcohol misuse screening (OR = 2.52, 95% CI:1.15, 5.56, P = .02).
Co-location of medical care in VA mental health clinics was associated with better quality for three out of nine indicators.
Given the increased comorbidity burden among VA patients with SMI, effective treatment models that enhance quality of medical care are sorely needed. Our findings suggest that co-located medical care may address gaps in quality of care for Veterans with SMI and provide an effective medical home model for this vulnerable group.