Improving Care for Patients with Bipolar Disorder

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DESCRIPTION (provided by applicant): Bipolar disorder is associated with significant personal and societal costs. Many of these costs and adverse outcomes are attributed to co-occurring general medical conditions. The specific aims of this R34 application are to adapt and pilot test a novel intervention to improve the quality of general medical and psychiatric care for patients with bipolar disorder within a community-based, network-model health plan setting. The intervention includes: 1) a Care Manager at the mental health carve-out level to coordinate medical and psychiatric care across providers, 2) patient self-management support, and 3) evidence-based guideline implementation adapted for patients with bipolar disorder (e.g., metabolic syndrome risk factor evaluation). The intervention will be adapted and standardized using an innovative framework (Participatory Management, or PM). PM involves the systematic incorporation of input from stakeholders on the customization of an intervention's core elements. Provider and consumer focus groups will be conducted to customize the intervention, and a cross-functional team will be implemented to refine the technical manual and address sustainability issues. The intervention will be pilot tested in eight mental health clinics: four randomized to receive the intervention and four receiving enhanced usual care. Eighteen patients diagnosed with bipolar disorder from each clinic will be followed for one year (total n=144). Primary outcomes include receipt of guideline-concordant medical and psychiatric care. The investigators are an experienced team from multiple disciplines: organizational behavior, implementation research, qualitative assessment, general medicine, chronic care model interventions, and statistics. Relevance of this research to public health: The PM process is a novel approach to facilitate adaptation and dissemination of treatment models across different settings. Individuals with bipolar disorder are disproportionately affected by general medical conditions. Because many individuals with bipolar disorder are active members of society, undertreated medical conditions can lead to increased economic costs due to missed work and poor functioning. While the majority of individuals receive care in mental health carve-out settings, there are currently no treatment models designed for network-model health plans to improve the management of general medical care for patients with bipolar or other mental disorders. Overall, this study will inform an innovative, R01 intervention that is generalizable to network-model health plans across the United States.