Lead/Presenter: Amy Cohen,
COIN - Los Angeles
All Authors: Cohen AN (VA HSR&D Center for Healthcare Innovation, Implementation, and Policy, Los Angeles), Chang ET (VA HSR&D Center for Healthcare Innovation, Implementation, and Policy, Los Angeles), Vinzon MF (Greater Los Angles VA Healthcare Center) Oberman RS (VA HSR&D Center for Healthcare Innovation, Implementation, and Policy, Los Angeles) Whelan F (UCLA, Biostatistics Core, Semel Institute) Young AS (VA HSR&D Center for Healthcare Innovation, Implementation, and Policy, Los Angeles)
This hybrid effectiveness-implementation trial implemented and evaluated an integrated model of primary and mental health care for a cohort of Veterans with serious mental illness.
A total of 331 individuals with serious mental illness, poor physical health (VA Care Assessment Need [CAN] score > 75 in last month or Emergency Department visit in last 6 months or medical inpatient stay in last 6 months), and substantial recovery from their mental illness (score of 6+ out of 8 on Milestones of Recovery Scale) were enrolled across three medical centers in VISN 22. A total of 164 individuals were assigned to comprehensive integrated care (SMI-PACT) and 167 continued with non-integrated care (PACT and specialty mental health). Veterans in SMI-PACT received care from a teamlet of a primary care physician, a nurse case manager, and a consulting psychiatrist. SMI-PACT clinicians were trained in serious mental illness, the associated cognitive deficits, and the use of motivational interviewing. SMI-PACT emphasized patient education, patient self-management, and functioning. SMI-PACT was delivered for 14 months. Pre- and post-assessments were conducted with patients.
The 331 enrolled Veterans included 36% with bipolar disorder, 32% with PTSD, 28% with schizophrenia/schizoaffective disorder, and 4% with major depression. The sample's average age was 57; 79% had at least some college; and 19% were working at least part-time. The sample's average CAN score was 85. Their average T-score for functioning was 38, meaning at baseline they were more than one standard deviation worse in functioning than the general population. The SMI-PACT group, as compared to the non-integrated group, had a significantly greater improvement in functioning as measured by the mental health component summary score of the Veterans RAND 12-item survey (F 1,252 = 3.9, p < .05). The SMI-PACT group moved within one SD of the general population, while the non-integrated group had no change. There were no significant differences between the 2 groups in any of the measures of mental health symptoms.
An integrated model of mental and physical health care (SMI-PACT) can be implemented in VA primary care and is shown to improve functioning in a vulnerable population with considerable chronic functioning deficits.
Consideration of spread of SMI-PACT is warranted.