Co-Location of Primary Care in VA Mental Health Clinics Associated with Better Processes of Care for Veterans with Serious Mental Illness
BACKGROUND:
Serious mental illness (e.g., schizophrenia, bipolar disorder) is associated with substantial functional impairment, high healthcare costs, and poor outcomes. Yet evidence suggests that those with serious mental illness (SMI) are less likely than those without SMI to receive quality care for medical conditions. Therefore, integrating medical care into mental health specialty programs is an optimal strategy for improving their quality of care. This study sought to determine the association between the co-location of primary care services and quality of medical care for patients with SMI receiving care in VA mental health clinics. Using VA data, investigators identified 105,100 Veterans diagnosed with SMI in FY06-07 from VA mental health clinics with complete VA Mental Health Program Survey data. Data from VA’s External Peer Review Program (EPRP) also was examined and included nine key process or outcome quality of care indicators representing elements of integrated care and conditions that disproportionately affect patients with SMI: diabetes foot/retinal exams, screening for cancer (colorectal, breast) and alcohol misuse, provision of tobacco counseling, hypertension control, and hemoglobin/lipid levels for Veterans with diabetes. Of the 107 mental health programs included in this study, 10 (10%) had co-located general medical clinics.
FINDINGS:
- The co-location of primary care services within VA mental health clinics was associated with better quality of care for Veterans with serious mental illness, particularly for key processes of care.
- After adjusting for organizational and patient-level factors, Veterans from co-located clinics were more likely to receive diabetes foot exams and screening for colorectal cancer and alcohol misuse (process measures), and to have satisfactory blood pressure control (outcome measure).
- Co-location was not associated with better outcomes for hemoglobin A1C levels among Veterans with diabetes.
- Observed quality of care in this sample exceeded national averages.
- Overall, integrated medical care may potentially provide an effective medical home model that can improve processes of medical care for Veterans with SMI.
LIMITATIONS:
- The survey used in this study was conducted in 2007. Since then, VA has initiated several programs related to integrated medical care for Veterans with mental disorders, including the Patient-Aligned Care Team (PACT) and the Primary Care-Mental Health Integration Program.
- The survey did not capture specific functions of integrated care beyond co-location (i.e., care management, use of registries, or panel management) or additional outcomes (i.e., hospitalizations, disease incidence, or mortality).
AUTHOR/FUNDING INFORMATION:
This study was partly funded through HSR&D (IIR 07-115). Dr. Kilbourne is part of HSR&D’s Center for Clinical Management Research in Ann Arbor, MI.
Kilbourne A, Pirraglia P, Lai Z, et al. Quality of General Medical Care in Patients with Serious Mental Illness: Does Co-Location of Services Matter? Psychiatric Services August 2011;62(8):922-28.
