BACKGROUND/RATIONALE:
People with serious mental illness (SMI) die, on average, many years prematurely, with rates of premature mortality are 2 to 3 times greater than the general population. Over 60% of premature deaths in this population are due to "natural causes," especially poorly treated cardiovascular, respiratory, and infectious diseases. Although the VA is a centrally organized, comprehensive healthcare system, Veterans with SMI still have difficulty navigating the system, and are at substantially elevated risk for premature death. Too often, they do not attend scheduled appointments or fail to engage in primary care treatment, and consequently do not get valuable preventive and primary care services.
Primary care in VA has undergone significant transformation under the Patent Aligned Care Team (PACT) model, which is based on the Patient Centered Medical Home (PCMH) concept. PACT has the goal of improving the quality, efficiency, and patient-centeredness of primary care. It remains unclear how PACT will impact the large populations of veterans who receive the majority of their care in specialty settings, such as people with SMI. Research can inform efforts to apply the PACT model in specialty settings. For example, while people with SMI do poorly with usual primary care arrangements, there is now substantial evidence that integrated care and medical care management approaches can improve medical treatment and outcomes, and reduce treatment costs, in people with SMI.

OBJECTIVE(S):
Using available evidence, we implement and evaluate a specialized PACT model that meets the needs of individuals with SMI ("SMI-PACT").

METHODS:
This project partners with leadership to implement SMI-PACT, with the goal of improving healthcare and outcomes among patients with SMI, while reducing unnecessary use of emergency and hospital services. Evidence-based quality improvement strategies are used to reorganize processes of care. In a site-level controlled trial, the project evaluates the effect, relative to usual care, of SMI-PACT implementation on (a) provision of appropriate preventive and medical treatments; (b) patient health-related quality of life and satisfaction with care; and (c) medical and mental health treatment utilization and costs. The project includes a mixed methods formative evaluation of usual care and SMI-PACT implementation to strengthen the intervention, and assess barriers and facilitators to its implementation. Mixed methods are used to investigate relationships between organizational context, intervention factors, and patient and provider outcomes; and identify patient factors related to successful patient outcomes.

FINDINGS/RESULTS:
None. This project is currently recruiting and enrolling.

IMPACT:
None. This project is currently recruiting and enrolling.

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External Links for this Project

NIH Reporter

Grant Number: I01HX000868-01A1
Link: https://reporter.nih.gov/project-details/8412363

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PUBLICATIONS:

Journal Articles

1. Young AS, Cohen AN, Chang ET, Flynn AWP, Hamilton AB, Oberman R, Vinzon M. A clustered controlled trial of the implementation and effectiveness of a medical home to improve health care of people with serious mental illness: study protocol. BMC health services research. 2018 Jun 7; 18(1):428. [view]
2. Chinchilla M, Greenberg JM, Chassman S, Oberman RS, Bergman AA, Chang ET, Cohen AN, Hamilton AB, Hovsepian S, Gabrielian SE, Young AS. Informing implementation and dissemination of a specialized primary care medical home for patients with serious mental illness: Clinician and administrator perspectives. Psychological Services. 2024 May 23. [view]
3. Bergman AA, Chang ET, Cohen AN, Hovsepian S, Oberman RS, Vinzon M, Young AS. Patient experiences with a primary care medical home tailored for people with serious mental illness. Families, systems & health : the journal of collaborative family healthcare. 2023 Nov 13. [view]
4. Young AS, Chang ET, Cohen AN, Oberman R, Chang DT, Hamilton AB, Lindamer LA, Sanford J, Whelan F. The Effectiveness of a Specialized Primary Care Medical Home for Patients with Serious Mental Illness. Journal of general internal medicine. 2022 Oct 1; 37(13):3258-3265. [view]
5. Young AS, Skela J, Chang ET, Oberman R, Siddarth P. Variation in benefit among patients with serious mental illness who receive integrated psychiatric and primary care. PLoS ONE. 2024 May 23; 19(5):e0304312. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: QUERI Implementation
MeSH Terms: none