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）作为改善当前美国医疗保健系统的交付系统创新已经被广泛讨论。提供者、支付者和政策制定者之间存在一种共识，即当前的初级保健系统以牺牲高质量的护理为代价奖励数量（Bitton， Martin和Landon， 2010）。因此，与其他国家相比，美国在可接受死亡率等领域落后，在获取和安全方面排名不佳（Barr, 2008）。继医学研究所2001年的一份报告呼吁致力于改善美国医疗保健的提供后，以患者为中心的医疗之家（PCMH）作为促进这些改进的提供系统创新被广泛讨论（Barr, 2008; Bolin, Gamm， Vest等人，2011;Davis, Schoenbaum, and Audet, 2005）。尽管有这些主张，一个不能解决心理健康问题的医疗保健服务系统将是不完整的，效率较低（DeGruy和Etz， 2010）。因此，在评估公私合作保健方案在改善其参与者健康方面的有效性时，必须包括对参与者心理健康的评估。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建立PCMH。PHIP将患有严重精神疾病的客户从县精神健康（MH）治疗方案转移到“初级保健医疗之家，进行药物监测、慢性疾病管理教育和咨询，并关注身体保健需求”（圣地亚哥县卫生与人类服务部，2009年）。本研究将探讨从县门诊医院转到PCMH对康复和服务利用的影响。本研究采用倾向得分分析（一种在没有随机化的情况下使用的严谨的统计技术），通过比较PCMH参与者与在县门诊医院接受常规服务（SAU）的类似客户，来评估PCMH对康复和服务利用的影响。拟议的研究将使用该县的大型行政数据集来检查PCMH的治疗服务利用率与县门诊MH诊所的差异，并将通过可靠和有效的标准化工具来评估治疗服务利用率是否影响康复。这个拟议的研究计划非常适合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。从提供者和参与者双方的角度评估PCMH对参与者心理健康恢复的影响，这是一种旨在增加服务可及性和提高服务质量的新型保健实施模式，将有助于深入了解这种有希望的治疗方法在多样化、服务不足的人群中发展的初始阶段的有效性。通过适当的传播技术，从本研究中获得的见解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.