From the Department of Health Policy and Management, Rollins School of Public Health, and the Department of Psychiatry, School of Medicine, Emory University, Atlanta.
Am J Psychiatry. 2017 Mar 1;174(3):246-255. doi: 10.1176/appi.ajp.2016.16050507. Epub 2016 Sep 15.
Behavioral health homes provide primary care health services to patients with serious mental illness treated in community mental health settings. The objective of this study was to compare quality and outcomes of care between an integrated behavioral health home and usual care.
The study was a randomized trial of a behavioral health home developed as a partnership between a community mental health center and a Federally Qualified Health Center. A total of 447 patients with a serious mental illness and one or more cardiometabolic risk factors were randomly assigned to either the behavioral health home or usual care for 12 months. Participants in the behavioral health home received integrated medical care on-site from a nurse practitioner and a full-time nurse care manager subcontracted through the health center.
Compared with usual care, the behavioral health home was associated with significant improvements in quality of cardiometabolic care, concordance of treatment with the chronic care model, and use of preventive services. For most cardiometabolic and general medical outcomes, both groups demonstrated improvement, although there were no statistically significant differences between the two groups over time.
The results suggest that it is possible, even under challenging real-world conditions, to improve quality of care for patients with serious mental illness and cardiovascular risk factors. Improving quality of medical care may be necessary, but not sufficient, to improve the full range of medical outcomes in this vulnerable population.
行为健康之家为在社区心理健康机构接受治疗的严重精神疾病患者提供初级保健服务。本研究的目的是比较综合行为健康之家和常规护理的护理质量和结果。
该研究是一项针对行为健康之家的随机试验，该健康之家是社区心理健康中心和联邦合格健康中心之间的合作项目。共有 447 名患有严重精神疾病和一个或多个心血管代谢危险因素的患者被随机分配到行为健康之家或常规护理组，接受为期 12 个月的治疗。行为健康之家的参与者接受现场的综合医疗服务，由执业护士和通过健康中心签约的全职护士护理经理提供。
与常规护理相比，行为健康之家在心血管代谢护理质量、治疗与慢性病护理模式的一致性以及预防服务的使用方面均有显著改善。对于大多数心血管代谢和一般医疗结果，两组均有所改善，尽管两组之间在时间上没有统计学上的显著差异。
结果表明，即使在具有挑战性的现实世界条件下，也有可能改善患有严重精神疾病和心血管风险因素患者的护理质量。改善医疗质量可能是必要的，但不足以改善这一脆弱人群的所有医疗结果。
