Using wellness coaches and extra support to improve the health and wellness of adults with serious mental illness / James Schuster.

Format:

Book

Author/Creator:

Schuster, James, author.

Series:

Final research report (Patient-Centered Outcomes Research Institute (U.S.))

Language:

English

Subjects (All):

Chronic diseases.

Physical Description:

1 online resource (43 pages) : illustrations.

Place of Publication:

Washington, D.C. : Patient-Centered Outcomes Research Institute, 2018.

Summary:

BACKGROUND: Individuals with serious mental illness (SMI) are vulnerable to chronic medical diseases and substantially decreased life expectancy. Many causes of morbidity and mortality are preventable or reversible with appropriate lifestyle modifications. Unfortunately, complex system-, provider-, and individual-level barriers can impede individuals with SMI from care that effectively prevents or manages chronic conditions. Community mental health centers (CMHCs) can help address the unmet medical needs of individuals with SMI, as they are often a primary point of contact with the health care system for this population. OBJECTIVES: The University of Pittsburgh Medical Center for High-value Health Care and patient, provider, and payer partners evaluated 2 promising interventions--provider-supported integrated care (provider-supported) and patient self-directed care (self-directed)--for promoting the health and recovery of adults with SMI.1. Primary Aim 1: Compare the effectiveness of the interventions on 3 primary patient-centered outcomes: patient activation in care, health status, and engagement in primary/specialty care.2. Primary Aim 2: Examine the moderating role of gender for the 3 primary patient-centered outcomes.3. Secondary Aim 1: Explore the impact of the interventions on secondary outcomes: hope, quality of life, functional status, care satisfaction, medication adherence, emergent care, and laboratory monitoring.4. Secondary Aim 2: Explore the mediating role of patient engagement in the interventions for primary and secondary outcomes. METHODS: The study population comprised Medicaid-enrolled adults diagnosed with SMI who received care at 1 of 11 CMHCs. We used a cluster randomized design and mixed-methods approach. We captured patient self-report measures and insurance claims at 5 time points across 2 years of implementation. We conducted qualitative interviews with service users and staff members to understand barriers and facilitators to intervention success and dissemination. Using generalized linear mixed models and generalized estimating equations, we analyzed the impact of interventions on primary and secondary outcomes. To assess heterogeneity of treatment effects, we analyzed the role of gender as a moderator. We used an editing approach to develop a qualitative analysis codebook and analyzed narratives for relevant themes. Finally, we employed a learning collaborative approach to support implementation. RESULTS: Among the 1229 men (37%) and women (63%) with SMI who were enrolled in the study, 713 participated in provider-supported and 516 participated in self-directed. The mean age of participants was 43, and most were White (90%). Over the 18 to 24 months of follow-up, intervention type had a differential impact on patient activation: Provider-supported participants experienced an increase in activation score at 6 months and self-directed participants experienced an increase at 18 months (P < .0001). Additionally, women in provider-supported were more likely to report increased activation compared with men (P < .0001). Both interventions positively affected mental health status (P < .0001) and engagement in primary/specialty care (P < .0001). Several secondary outcomes improved, although perceived physical health status declined (P < .0001). CMHC staff and service users reported positive experiences in both interventions. We identified barriers (eg, staff turnover, lack of service user motivation to change health habits) and facilitators (eg, integration of intervention components into routine practice, availability of a wellness nurse [provider-supported only]) to intervention success. Use of the learning collaborative allowed for consistent improvement on process and outcomes goals over time and promoted high levels of implementation. All sites continue to implement the interventions poststudy, and staff at additional CMHCs have been trained and supported to deliver similar models of care. CONCLUSIONS: Both provider-supported and self-directed affected patient-centered outcomes, including patient activation, engagement in primary/specialty care, and quality of life. This study promotes national efforts to avoid comorbidity and early mortality among individuals with SMI and provides information about scalable models that hold promise for successful uptake in other behavioral health treatment settings. LIMITATIONS: Our use of historical claims data limited the accuracy of prestudy eligibility estimates at each study site, resulting in lower enrollment, a sample size imbalance across study arms, and reduced statistical power to conduct proposed heterogeneity of treatment effect analyses beyond the role of gender. The completeness of self-report data across all 5 time points is a clear limitation but not unexpected in the context of real-world community mental health settings. Our use of claims data enhanced data completeness, thereby permitting examination of the intervention's impact on several important patient-centered outcomes.

Contents:

Background

Stakeholder Participation

Methods

Results

Discussion

Conclusions

References

Related Publications

Acknowledgments.

Notes:

Description based on publisher supplied metadata and other sources.