Mental Health Recovery in the Patient Centered Medical Home

描述(由申请人提供)：以患者为中心的医疗之家(PCMH)作为一种改善当前美国医疗保健体系的交付系统创新已被广泛讨论。提供者、付款人和政策制定者之间存在一个共识，即当前的初级保健制度以牺牲高质量的保健为代价来奖励数量(Bitton，Martin和Landon，2010)。因此，与其他国家相比，美国在可接受死亡率等方面落后，在可获得性和安全性方面排名较差(Barr，2008)。美国医学研究所2001年的一份报告呼吁致力于改善美国的医疗保健服务，之后，以患者为中心的疗养院(PCMH)作为促进这些改进的交付系统创新而被广泛讨论(Barr，2008；Bolin，Gamm，Vest等，2011；Davis，Schoenbaum和Audet，2005)。尽管有这些主张，但未能解决精神健康问题的医疗保健提供系统将是不完整的，也不那么有效(DeGruy和Etz，2010)。因此，对PCMH在改善参与者健康方面的有效性的评估必须包括对参与者的心理健康的评估。圣地亚哥县身体健康综合项目(PhIP)旨在为患有严重精神疾病的个人创建PCMH。PHIP将患有严重精神疾病的客户从县精神卫生(MH)治疗计划过渡到“初级保健医疗之家，用于药物监测、慢性病管理教育和咨询，并关注身体健康需求”(圣地亚哥县卫生与公众服务局，2009)。这项拟议的研究将考察从县门诊MH诊所转移到PCMH对康复和服务利用的影响。使用倾向评分分析，这是一种在没有随机化的情况下使用的方法上严格的统计技术，本研究将通过将PCMH参与者与在县门诊MH诊所接受照常服务(SAU)的类似客户进行比较，来评估PCMH对康复和服务利用的影响。拟议的研究将使用县的大量行政数据集来检查与县门诊部MH诊所相比，PCMH在治疗服务利用方面的差异，并将检查通过可靠和有效的标准化工具评估的治疗服务利用是否影响康复。这项拟议的研究计划与NIMH的第三个战略计划目标3.3和第四个战略计划目标4.1非常吻合。从提供者和参与者的角度评估PCMH对参与者心理健康恢复的影响，这是一种旨在增加可获得性和提高服务质量的新的卫生保健实施模式，将从其在多样化、服务不足的人群中发展的初始阶段提供对这一有前景的治疗的有效性的洞察。通过适当的传播技术，从这项研究中获得的洞察力可以指导未来的治疗工作。

DESCRIPTION (provided by applicant): The patient-centered medical home (PCMH) has been discussed extensively as a delivery system innovation for improving the current United States health care system. A consensus exists among providers, payers, and policymakers that the current primary care system rewards quantity at the sacrifice of high quality care (Bitton, Martin and Landon, 2010). As a result, the United States is falling behind in comparison to other countries in areas such as amenable mortality and ranks poorly on access and safety (Barr, 2008). Following a 2001 report of the Institute of Medicine calling for a commitment to improve the delivery of health care in the United States, the patient-centered medical home (PCMH) has been discussed extensively as a delivery system innovation for facilitating these improvements (Barr, 2008; Bolin, Gamm, Vest, et al., 2011, Davis, Schoenbaum, and Audet, 2005). Despite these claims, a healthcare delivery system that fails to address mental health will be incomplete and less effective (DeGruy and Etz, 2010). As a result, the assessment of the effectiveness of the PCMH in improving the health of its participants must include an assessment of participants' mental health. The San Diego County Physical Health Integration Project (PHIP) aims to create a PCMH for individuals with severe mental illness. The PHIP transitions clients with severe mental illness from County mental health (MH) treatment programs to a "primary care medical home for medication monitoring, chronic disease management education and counseling, and attention to physical health care needs" (County of San Diego Health and Human Services Agency, 2009). This proposed study will examine the impact of moving from a County outpatient MH clinic to a PCMH on recovery and service utilization. Using propensity score analysis, a methodologically rigorous statistical technique used in the absence of randomization, this study will assess the impact of the PCMH on recovery and service utilization by comparing PCMH participants to similar clients receiving service as usual (SAU) in County outpatient MH clinics. The proposed study will use the County's large administrative data set to examine the differences in treatment service utilization of the PCMH in comparison to County outpatient MH clinics, and will examine whether treatment service utilization impacts recovery as assessed by reliable and valid standardized instruments. This proposed research plan is an excellent fit with NIMH's third strategic plan objective 3.3 and fourth strategic plan objective 4.1. Evaluation of th effects of the PCMH, a novel model of implementing health care proposed to increase access and improve quality of services, on participants' mental health recovery from the perspectives of both the providers and the participants will provide insight into the effectiveness of this promising treatment from the initial stages of its development within a diverse, underserved population. With appropriate dissemination techniques, the insight gained from this research study can guide future treatment efforts.