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

患有严重精神疾病（SMI）的人有严重不良健康的风险， 与一般人群相比，由于慢性物理疾病的高患病率， 健康障碍，如心血管疾病、高血压和II型糖尿病，沿着 精神痛苦的后果，如自杀，药物滥用和急性压力。共病 这一人群的医疗和心理健康问题往往导致更高的医疗费用和不良后果。 健康成果。虽然存在针对这些病症的药物治疗，但它们具有有限的 在SMI人群中的有效性，因为：（1）高达60%的SMI患者不服用 精神科或躯体药物处方，（2）与SMI的个人有较差的临床 结果和经历高住院率，和（3）具有SMI经历的个体 更糟糕的照顾。在管理这些复杂的慢性健康和心理健康的挑战 条件导致制定了密集的社区服务提供方案。 然而，按照目前的结构，这些密集的面对面干预措施的影响有限 优化服务的提供，并因此对坚持治疗和健康结果产生影响。而 在某些情况下，面对面的临床接触是重要的，远程保健可以作为一种有效的 灵活的干预措施，以帮助满足重度精神病患者对临床干预的高度需求， 特别是那些具有地理上受限的服务访问的用户。尽管有研究表明， 远程医疗对重度精神疾病患者的有效性，大多数针对这一人群的现有干预措施 设计用于机构环境，而不是社区环境，因为采用 远程保健，如数字技术的获取有限、技术支持困难和 必要的技术。COVID-19大流行强调了制定有效的 远程医疗和远程监护技术，以满足这一弱势群体的独特需求 in community社区settings设置.该项目建立在一个成功的第一阶段SBIR项目和正在进行的第二阶段 Medherent可持续药物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，可用于满足广泛的健康需求， 被诊断患有SMI的人生活在社区环境中，并得到社区精神卫生服务的支持。 卫生机构。我们将招募300人，其中包括200名目前正在使用该设备的人 和100个新用户该研究将测试现有的Medherent平台和一套 延伸服务。我们的主要成果包括急性服务的使用，预防和其他 健康检查、健康结果和服务成本。本研究将使用阶梯式楔块 采用匹配的对照组设计方法，以确定干预的潜在益处。

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.