Bringing Health Home: Evaluation of a Residential-based Telehealth Care Coordination Intervention

患有严重精神疾病(SMI)的个人面临严重不利健康和 与普通人群相比的社会结果，因为慢性体力活动的高患病率 健康障碍，如心血管疾病、高血压和II型糖尿病，以及 精神痛苦的后果，如自杀、药物滥用和急性压力。合并症： 这一人群中的医疗和心理健康问题往往会导致更高的医疗费用和不利的 健康结果。虽然存在针对这些疾病的药物治疗，但它们有限 对SMI人群的有效性是因为：(1)高达60%的SMI患者没有服用他们的 按处方进行精神或躯体药物治疗；(2)重度精神障碍患者的临床症状较差 结果和经历高住院率，以及(3)有SMI经历的人 更糟糕的照顾。管理这些复杂的慢性健康和精神健康面临的挑战 条件导致了密集的以社区为基础的服务提供方案的发展。 然而，按照目前的结构，这些密集的面对面干预只产生了有限的影响 优化服务提供，并因此坚持治疗和健康结果。而当 在特定情况下面对面的临床接触很重要，远程医疗可能是一种有效和 灵活干预，帮助满足SMI人群临床干预的高需求 尤其是那些服务访问受地理限制的公司。尽管已有关于 SMI人群远程保健的有效性，大多数现有的针对这一人群的干预措施都有 是为机构环境而不是社区环境设计的，因为采用 远程保健，例如获取数字技术的机会有限、技术支持困难和 必要的技术。新冠肺炎大流行凸显了制定有效发展战略的必要性 远程医疗和远程监测技术，以满足这一弱势群体的独特需求 在社区环境中。该项目建立在成功的第一阶段SBIR项目和正在进行的第二阶段基础上 Medherent用药管理平台的临床试验。这项研究将测试一个扩展的 一套远程医疗保健协调服务，可用于满足 被诊断患有SMI的个人生活在社区环境中并得到社区心理支持 卫生机构。我们将招募300人，其中包括200名目前使用该设备的人 和100个新的设备用户。这项研究将测试现有的Medherent平台和一套 扩展服务。我们的主要成果包括紧急服务使用、接受预防性服务和其他 健康筛查、健康结果和服务费用。这项研究将使用阶梯式楔形板 设计方法与匹配的对照组，以确定干预的潜在好处。

Individuals suffering from Serious Mental Illnesses (SMI) are at risk for serious adverse health and social outcomes compared to the general population due to a high prevalence of chronic physical health disorders such as cardiovascular disease, hypertension, and Type II Diabetes, along with consequences of mental distress such as suicide, substance abuse, and acute stress. Comorbidity of medical and mental health issues in this population often lead to higher medical costs and adverse health outcomes. While pharmacological treatments exist for these conditions, they have limited effectiveness in SMI populations because: (1) up to 60% of individuals with SMI do not take their psychiatric or somatic medications as prescribed, (2) individuals with SMI have poorer clinical outcomes and experience high rates of hospitalizations, and (3) individuals with SMI experience worse care. Challenges in the management of these complex chronic health and mental health conditions have led to the development of intensive community-based service delivery programs. However, as currently structured these intensive in-person interventions have only had limited impact optimizing service delivery, and consequently on adherence to treatment and health outcomes. While in-person clinical contact in select situations is important, telehealth may serve as an effective and nimble intervention to help meet the high need for clinical intervention for SMI populations and particularly those with geographically limited-service access. Although research exists regarding the efficacy of telehealth with SMI populations, most of the existing interventions with this population have been designed for institutional settings, not community settings, because of barriers to adoption of telehealth such as limited access to digital technology, technical support difficulties and cost of necessary technology. The COVID-19 pandemic has underscored the need for developing effective telemedicine and telemonitoring technologies to serve the unique needs of this vulnerable population in community settings. This project builds on a successful Phase I SBIR project and ongoing Phase II clinical trial of the Medherent medication management platform. This study will test an expanded set of telehealth care-coordination services that can be used to address the broad health needs of individuals diagnosed with SMI living in community settings and supported by community mental health agencies. We will recruit 300 individuals, including 200 individuals currently using the device and 100 new users of the device. The study will test the existing Medherent platform and a set of extended services. Our key outcomes include acute service use, receipt of preventive and other health screenings, health outcomes and costs of services. The study will use a Stepped Wedge Design approach with a matched comparison group to identify potential benefits of the intervention.