Collaborative Care Models Improve Physical and Mental Health Outcomes for Individuals with Mental Disorders
Disease management strategies, including collaborative chronic care models (CCMs), have been used to enhance depression treatment in primary care, and have begun to be applied to other mental health conditions in a variety of settings. In addition, CCMs have entered clinical practice guidelines for some serious mental illnesses. If CCMs do have a beneficial impact on a variety of mental health conditions across various settings, the model could provide a coherent approach by which to structure care for this complex population, integrating with patient-centered medical homes that use CCM-based approaches. Therefore, this study utilized systematic review and meta-analysis to assess the comparative effectiveness of CCMs for mental health conditions across disorders and treatment settings. Investigators identified 78 articles that yielded analyses from 57 randomized controlled trials of CCMs vs. other care conditions published or in press through 8/15/11. CCMs were defined as interventions having >3 of 6 "improving chronic illness care" elements: patient self-management support, clinical information systems, delivery system redesign, decision support, organizational support, and community resources. Outcomes that were measured included: CCM impact on mental health symptoms or mental quality of life, social role function, physical and overall quality of life, and costs.
- CCMs can improve mental and physical outcomes for individuals with mental disorders across a wide variety of care settings and provide a robust clinical and policy framework for care integration.
- Meta-analysis of unadjusted outcomes demonstrated significant small-to-medium effects of CCMs across multiple disorders in clinical symptoms, mental and physical quality of life, and social role function, with no net increase in total healthcare costs. Systematic review of a broader range of studies largely confirmed meta-analytic findings.
- The authors suggest that CCMs provide a framework of broad applicability for management for a variety of mental health conditions across a wide range of treatment settings, as they do for chronic medical illnesses.
- The majority of the evidence was derived from studies of depression treated in primary care.
- This study likely underestimates CCM effects by including analyses that were not primary trial outcomes and, thus, not necessarily adequately powered.
This study was partly funded by HSR&D (IIR 10-314). Dr. Kilbourne is Associate Director of VA's National Serious Mental Illness Treatment Resource and Evaluation Center and is with HSR&D's Center for Clinical Management Research, Ann Arbor, MI. Dr. Bauer is Associate Director of HSR&D's Center for Organization, Leadership, & Management Research, Boston, MA.
Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne A, and Bauer M. Comparative Effectiveness of Collaborative Chronic Care Models for Mental Health Conditions across Primary, Specialty, and Behavioral Health Care Settings: Systematic Review and Meta-Analysis. American Journal of Psychiatry August 1, 2012;169(8):790-804.