| PACT for Individuals With Serious Mental Illness
What is the primary objective of this study?
People with serious mental illness have difficulty making good use of primary care, and die, on average, years earlier than others in the population. The greatest contributors to this premature mortality are medical illnesses, especially cardiovascular disease and cancer. The Patient Centered Medical Home is a model for reorganizing primary care practice so that healthcare is more effective, efficient, and user-friendly. It has been implemented across VA as the, \"Patient Aligned Care Team\" (PACT). It is unclear, however, how this PACT model applies to people whose predominant illness is treated by specialists. This is the case for people with serious mental illness (SMI), many of whom receive ongoing treatment at mental health clinics. To achieve optimal health outcomes in the population with SMI, it may be necessary to adapt the PACT model so that it includes approaches that have proven to improve healthcare in this population. This project implements an adapted \"SMI-PACT\" model, and evaluates its effect on Veterans with SMI.
Who is eligible to participate?
Inclusion Criteria: - All patient subjects and all staff subjects are currently enrolled in care at one of the 3 sites for this study. - All patient subjects will be Veterans. Patient subjects: - The investigators will enroll a random sample of 340 patients who have diagnoses of schizophrenia - schizoaffective disorder - bipolar disorder - chronic PTSD - or recurrent major depression with psychosis Staff subjects: - The investigators will enroll approximately 15 staff per site. - At each site this will include: - 3 members of PACT - 4 members of SMI-PACT (intervention site) or mental health integration (control site) - 4 providers from the mental health clinic - 2 administrators who oversee the mental health clinic (e.g., psychiatry, psychology, nursing, social work, clerks) - and 2 administrators who oversee primary care. Exclusion Criteria: - Patients will not be excluded based on comorbid mental or medical diagnoses. - However, there is a subset of individuals at mental health clinics who are psychiatrically stable and advanced enough in their recovery that they do not require high intensity mental health supports to make effective use of PACT. - This will be assessed at baseline by each patient's clinician, using the Milestones of Recovery Scale (MORS)scale. - This scale rates an individual's ability to self-manage their care. - Patients who rate at \"early recovery\" or \"advanced recovery\" on this scale will remain with standard PACT, and are not eligible for SMI-PACT.
Which medical condition, disease, disorder, syndrome, illness, or injury is researched?
Interventions can include giving participants drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available or noninvasive approaches such as surveys, education, and interviews.
Other:Patient Aligned Care Team (PACT)A integrated healthcare model to coordinate and address physical health needs. The PACT model to be implemented here will be specially designed for individuals with serious mental illness.
Research studies and clinical trials typically have two or more research arms. An arm is a group of people who receive the same treatment in the study.
SMI-PACTPatient Aligned Care Team (PACT) medical home model to address the physical healthcare needs for individuals with serious mental illness
Usual CarePrimary Care
Start Date: September 1, 2015
Completed Date: December 31, 2018
Primary Outcome: Composite Prevention Score
Secondary Outcome: Composite Diabetes Mellitus Score
Study sponsors, principal investigator, and references
Principal Investigator: Alexander Stehle Young, MD MSHS
Lead Sponsor: VA Office of Research and Development