INTEGRATING PHYSICAL AND MENTAL CARE FOR ADULTS WITH SERIOUS MENTAL ILLNESS

描述（由申请人提供）：重度精神疾病（SMI）患者的身体健康状况是一种公共卫生危机。重度精神障碍患者（如精神分裂症、双相情感障碍或严重抑郁症）比一般人群更有可能患有身体健康状况，包括高血压、糖尿病、肥胖、心血管疾病、艾滋病毒和肝炎。重度精神分裂症与预期寿命减少约9年有关，其中约一半可归因于身体健康状况。获得卫生保健的机会少、质量低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业精神卫生诊所中，这些诊所已经成为他们进入医疗系统的主要门户。然而，这一战略能否在全系统范围内实现对重度精神障碍患者护理的持续改善，还有待检验。该项目利用纽约州两个创新的综合护理项目和一个独特的数据资源，评估将初级保健服务整合到重度精神障碍患者的专业行为健康诊所的潜在影响。纽约的第一个综合护理项目是通过药物滥用和精神卫生服务管理局（SAMHSA）的示范项目，即初级行为卫生保健综合（phhci）赠款项目建立的。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，以评估该项目的有效性。第二个综合护理项目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，促进专业行为健康诊所的初级保健服务。OMH方案的规模比SAMHSA拨款方案大得多，它对卫生保健的影响还有待实证检验。在这个项目中，兰德研究团队与纽约大学的一个研究团队合作，该团队在纽约精神卫生办公室的精神卫生保健研究质量方面具有丰富的经验。我们将一起审查综合护理的财务可行性

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.