Monday, August 7, 2017

Integrated Behavioral Health Home Program May Benefit Patients With Psychotic, Bipolar Disorders

Participation in a behavioral health home (BHH) program by patients with serious mental illness was associated with significant reductions in emergency department (ED) visits and psychiatric hospitalizations, and increased HbA1c monitoring, according to a study in Psychiatric Services in Advance.

“The study extends existing literature by evaluating a clearly defined BHH program that was implemented in a safety-net institution for use by adults with schizophrenia spectrum disorders or bipolar disorder,” wrote lead author Miriam C. Tepper, M.D., a psychiatrist affiliated with Cambridge Health Alliance in Somerville, Mass., and colleagues. 

Data were collected from electronic health records (EHRs) in an urban academic medical system in Massachusetts that provides a full continuum of care to more than 140,000 patients annually. Records of 424 patients (n=369, psychotic disorder; n=55, bipolar disorder) assigned to BHH were compared with 1,521 individuals with the same diagnoses who were not enrolled in the BHH. 

The BHH implemented four key general medical and psychiatric service enhancements: 1) On-site medical care, health promotion, support for care coordination and transitions, and peer-to-peer engagement opportunities; 2) Enhanced EHR functionality including provider alerts for patient transitions, a registry for monitoring individuals’ health status and service delivery, acute care discharge reports to facilitate follow-up, and a performance measurement dashboard; 3) The addition of three new positions—a nurse practitioner, care manager, and program manager—to supplement the existing clinical team; and 4) Shifting clinical practice toward fully integrated, team-based care organized around group therapy modalities, health promotion, chronic disease screening and monitoring, social inclusion, and population management.

During the 12-month study period, the total number of ED visits per capita among BHH patients decreased significantly from 1.45 to 1.19 visits, while total ED visits rose in the control group from 0.99 to 1.16. Total psychiatric hospitalizations per capita declined for the BHH patients (from 0.22 to 0.10), but remained stable in the control group (from 0.145 to 0.147). Screening rates for HbA1c increased more among BHH patients (from 0.49 to 0.64) than among control group patients (from 0.40 to 0.46). 

The BHH had no effect on rates of general medical hospitalization or LDL screening or on values of metabolic parameters for diabetic patients over the 12-month period. 

“The lack of association between BHH participation and reductions in general medical inpatient utilization was unexpected,” the authors wrote. “One possible explanation is that intervention components emphasize health promotion activities that are designed to improve long-term health rather than stem acute medical service utilization.”

For related information, see the Psychiatric News article “New York State’s Path to Behavioral Health Integration,” by Jay Carruthers, M.D., and Lloyd Sederer, M.D.

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