INTEGRATING PHYSICAL AND MENTAL CARE FOR ADULTS WITH SERIOUS MENTAL ILLNESS

描述(申请人提供)：严重精神病患者的身体健康状况是一种公共健康危机。SMI患者(如精神分裂症、双相情感障碍或严重抑郁症)比一般人群更容易出现身体健康问题，包括高血压、糖尿病、肥胖症、心血管疾病、艾滋病毒和肝炎。SMI与预期寿命减少约9年有关，其中约一半可归因于身体健康状况。缺乏机会和低质量的卫生保健是造成这些差距的原因之一。改善重度精神障碍患者健康的一个主要建议是将初级保健服务整合到专门的精神卫生诊所，这些诊所已经成为他们进入医疗系统的主要门户。然而，这一战略在全系统范围内实现对SMI患者护理的持续改善的可行性尚未得到检验。该项目利用纽约州的两个创新的综合保健计划和一个独特的数据资源来评估将初级保健服务整合到专门的行为健康诊所对SMI患者的潜在影响。纽约第一个综合保健计划是通过物质滥用和精神卫生服务管理局(SAMHSA)示范项目初级行为保健综合(PBHCI)赠款计划建立的。兰德公司从SAMHSA和负责规划和评估的助理部长(ASPE)那里获得了一份合同，以评估该计划的有效性。第二个综合保健计划是由纽约心理健康办公室发起的，利用医疗补助报销激励措施在专门的行为健康诊所推广初级保健服务。与SAMHSA赠款计划相比，OMH计划的规模要大得多，但它对医疗保健的影响尚未得到实证检验。在这个项目中，兰德研究团队加入了纽约大学的一个研究团队，该团队在纽约心理健康办公室的心理健康研究质量方面拥有丰富的经验。我们将一起研究综合保健的财务可行性 从诊所的角度来看，从卫生系统的角度来看，综合保健对卫生保健利用、质量、广告成本的影响；从付款人的角度，综合保健对长期预算的影响。这项评估的数据来自医疗补助索赔数据的唯一来源。如果这种模式成功，那么扩大其可获得性可能会对SMI患者的身体健康状况产生巨大影响，有助于减少当代最明显的健康差距之一。确定这一模式的可行性是迫在眉睫的，因为公共部门精神卫生保健的预期增长，以及旨在激励SMI患者综合护理的州级计划。

DESCRIPTION (provided by applicant): The physical health status of people with severe mental illness (SMI) is a public health crisis. Individuals with SMI (e.g. schizophrenia, bipolar disorder, or severe depression) are more likely than the general population to suffer from physical health conditions, including hypertension, diabetes, obesity, cardiovascular disease, HIV, and hepatitis. SMI is associated with a reduction of about 9 years in life expectancy, about half of which is attributable to physical health conditions. Poor access to and low quality of health care contributes to these disparities. A leading proposal for improving the health of people with SMI is to integrate primary care services into specialty mental health clinics which already serve as their primary gateway into the medical system. However, the viability of this strategy to achieve sustained system-wide improvements in care for people with SMI has yet to be examined. This project takes advantage of two innovative integrated care programs and a unique data resource in New York State to assess the potential impact of integrating primary care services into specialty behavioral health clinics for people with SMI. The first integrated care program in New York was established through a Substance Abuse and Mental Health Services Administration (SAMHSA) demonstration project, the Primary Behavioral Health Care Integration (PBHCI) grant program. The RAND Corporation was awarded a contract from SAMHSA and the Assistant Secretary for Planning and Evaluation (ASPE) to evaluate the effectiveness of this program. The second integrated care program was initiated by the New York Office of Mental Health using a Medicaid reimbursement incentive to promote primary care services in specialty behavioral health clinics. The OMH program, which is on a much larger scale than the SAMHSA grant program, has yet to be examined empirically with respect to its impact on health care. For this project, the RAND research team has joined with a research team at NYU with extensive experience with quality of mental health care research in New York's Office of Mental Health. Together we will examine the financial viability of integrated care from the clinics' perspective, the impact of integrated care on health care utilization, quality, ad cost from a health system perspective and the long term budget impact of integrated care from the payer perspective. Data for this evaluation come from a unique resource of Medicaid claims data. If this model is successful, then expanding its availability could have a dramatic impact on the physical health status of people with SMI, helping to reduce one of the starkest of contemporary disparities in health. Determining the viability of this model is urgent because of the anticipated growth of public sector mental health care and in state-level programs designed to incentivize integrated care for people with SMI.