PACT to Improve Health Care in People With Serious Mental Illness (SMI-PACT)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 331
- 试验地点
- 6
- 主要终点
- Provision of Appropriate Preventive and Medical Treatments
研究概览
简要总结
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.
详细描述
Background/Rationale:
People with serious mental illness (SMI) die, on average, many years prematurely, with rates of premature mortality 2 to 3 times greater than the general population. Over 60% of premature deaths in this population are due to "natural causes," especially poorly treated cardiovascular, respiratory, and infectious diseases. Although the VA is a centrally organized, comprehensive healthcare system, Veterans with SMI still have difficulty navigating the system, and are at substantially elevated risk for premature death. Too often, they do not attend scheduled appointments or fail to engage in primary care treatment, and consequently do not get valuable preventive and primary care services.
Primary care in VA has undergone significant transformation under the Patent Aligned Care Team (PACT) model, which is based on the Patient Centered Medical Home (PCMH) concept. PACT has the goal of improving the quality, efficiency, and patient-centeredness of primary care. But it remains unclear how PACT will impact the large populations of Veterans whose predominant illness is treated in specialty settings, such as people with SMI. Research can inform efforts to apply the PACT model. For example, while people with SMI do poorly with usual primary care arrangements, there is substantial evidence that integrated care and medical care management approaches can improve medical treatment and outcomes, and reduce treatment costs, in people with SMI.
Objective:
Using available evidence, the investigators propose to implement and evaluate a specialized PACT model that meets the needs of individuals with SMI ("SMI-PACT").
研究设计
- 研究类型
- Interventional
- 分配方式
- Non Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Patient subjects:
- •currently enrolled at one of the 3 participating VA healthcare centers
- •diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, chronic severe PTSD, or recurrent major depression with psychosis
- •Milestone of Recovery Scale (MORS) score is 6 or above (indicates recovery status is coping rehabilitating or better)
- •Staff subjects:
- •employed at one of the 3 participating VA healthcare centers
- •member of PACT, member of SMI PACT, member of primary care mental health integration, provider at mental health clinic, administrator overseeing mental health, or administrator overseeing primary care
排除标准
- 未提供
结局指标
主要结局
Provision of Appropriate Preventive and Medical Treatments
时间窗: 15 months
Screened for body mass index, blood pressure, lipids, and glucose or hemoglobin A1c.
Patient Health-related Quality of Life: Veterans RAND 6 Item Health Survey (VR-6) Mental Health
时间窗: 15 months
Mental health related quality of life. The scale range is 0 to 100. Higher scores mean a better outcome.
Patient Satisfaction With Care: Ambulatory Care Experiences Survey (ACES; Short Form)
时间窗: 15 months
Evaluates patients' experiences and satisfaction with a physician's practice. The ACES uses the Institute of Medicine definition of primary care as its underlying conceptual model for measurement. The ACES range is 0 to 100. Higher scores mean a better outcome.
Patient Health-related Quality of Life: Veterans RAND 6 Item Health Survey (VR-6) Physical Health
时间窗: 15 months
Physical health related quality of life. The scale range is 0 to 100. Higher scores mean a better outcome.
Patient Satisfaction With Care: Patient Assessment of Chronic Illness Care (ACIC/PACIC)
时间窗: 15 months
Assesses the patient's experience and satisfaction with receipt of chronic care. This measure aligns with the Chronic Care Model. The ACIC/PACIC ranges from from 1 to 5. Higher scores mean a better outcome.
次要结局
未报告次要终点