Health Services Research & Development

Veterans Crisis Line Badge
Go to the ORD website
Go to the QUERI website

SDP 12-177 – HSR&D Study

New | Current | Completed | DRA | DRE | Portfolios/Projects | Centers | Career Development Projects

SDP 12-177
PACT to Improve Health Care in People with Serious Mental Illness (SMI-PACT)
Alexander Stehle Young MD MSHS
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: January 2014 - September 2019

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.

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.
Journal Other

  1. Chang ET, Vinzon M, Cohen AN, Young AS. Effective Models Urgently Needed to Improve Physical Care for People With Serious Mental Illnesses. Health services insights. 2019 Apr 2; 12:1178632919837628.


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