Excerpt

Individuals with serious mental illness (SMI) have shortened life expectancies relative to the general population to an extent that is not explained by unnatural causes such as suicide or accidents. Numerous studies show higher rates of acute and chronic illnesses, lower quality general medical care and worse outcomes in individuals with SMI. The issues that influence general medical outcomes for individuals with SMI are complex and overlapping and likely vary by disease state. Relevant factors can be categorized to include population characteristics, contextual and system factors, provider factors, and community resources. Interventions aimed at improving general medical outcomes in this population could be directed at any one, or several, of these factors. The organization of service delivery for individuals with SMI may be the most modifiable of the many factors that impact general medical outcomes in this population. In this review, we sought to evaluate models of care designed to improve general medical outcomes among individuals with SMI.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • DATA SYNTHESIS
  • PEER REVIEW
  • RESULTS
  • ABBREVIATIONS TABLE
• INTRODUCTION
  • BACKGROUND
• METHODS
  • TOPIC DEVELOPMENT
  • ANALYTIC FRAMEWORK
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • STUDY CHARACTERISTICS
  • KEY QUESTION 1 What types of care models have been evaluated prospectively that integrate mental health care and primary medical care with the goal of improving general medical outcomes for individuals with serious mental illness (SMI)?
  • KEY QUESTION 2 Do models of integrated care for individuals with SMI improve the process of care for preventive services (e.g., colorectal cancer screening) and chronic disease management (e.g., annual eye examination in patients with diabetes mellitus [DM]?
  • KEY QUESTION 3 (3a) Do models of integrated care for individuals with SMI improve general functional status outcomes (e.g., as measured by SF-36) or disease-specific functional status outcomes (e.g., Seattle Angina Questionnaire) related to medical care for chronic medical conditions such as DM, hypertension, or heart failure? (3b) Do models of integrated care for individuals with SMI improve clinical outcomes related to preventive services (e.g., influenza rates) and chronic medical care (e.g., kidney disease, amputations, retinopathy in patients with coexisting DM)?
  • KEY QUESTION 4 What are the gaps in evidence for determining how best to integrate care to improve general medical outcomes for individuals with SMI?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • LIMITATIONS
  • RECOMMENDATIONS FOR FUTURE RESEARCH
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B STUDY SELECTION FORM
• APPENDIX C CRITERIA USED IN QUALITY ASSESSMENT
• APPENDIX D PEER REVIEW COMMENTS/AUTHOR RESPONSES
• APPENDIX E EXCLUDED STUDIES
• APPENDIX F GLOSSARY

Medical Editor: Liz Wing, MA

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Durham Veterans Affairs Healthcare System, Durham, NC, John W. Williams Jr., MD, MHSc, Director.

Suggested citation:

Bradford DW, Slubicki MN, McDuffie JR, Kilbourne AM, Nagi A, Williams JW Jr. Effects of Care Models to Improve General Medical Outcomes for Individuals With Serious Mental Illness. VA-ESP Project #09-010; 2011

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Durham VA Medical Center, Durham, NC, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.