Boston Center for Organization

Boston, MA, United States

Boston Center for Organization

Boston, MA, United States

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Kilbourne A.M.,Ann Arbor Center for Clinical Management Research | Kilbourne A.M.,University of Michigan | Greenwald D.E.,Pittsburgh Center for Health Equity Research and Promotion | Bauer M.S.,Boston Center for Organization | And 4 more authors.
Administration and Policy in Mental Health and Mental Health Services Research | Year: 2012

Integrated care for medical conditions is essential for persons with serious mental illness (SMI). This qualitative study describes mental health provider perspectives regarding barriers and facilitators of integrated care for patients with SMI. We interviewed providers from a national sample of Veterans Health Administration facilities that scored in the top or bottom percentile in medical care quality. Providers from high-performing sites reported substantial in-person contacts with general medical providers, while providers from low-performing sites reported stigma and limited communication with medical providers as major concerns. Interventions to improve mental health and medical provider communication may facilitate integrated care for persons with SMI. © Springer Science+Business Media, LLC (outside the USA) 2011.


Kilbourne A.M.,Serious Mental Illness Treatment Resource and Evaluation Center | Pirraglia P.A.,Providence Medical Center | Lai Z.,Serious Mental Illness Treatment Resource and Evaluation Center | Bauer M.S.,Boston Center for Organization | And 4 more authors.
Psychiatric Services | Year: 2011

Objective: This study was conducted to determine whether patients with serious mental illness receiving care in Veterans Affairs (VA) mental health programs with colocated general medical clinics were more likely to receive adequate medical care than patients in programs without colocated clinics based on a nationally representative sample. Methods: The study included all VA patients with diagnoses of serious mental illness in fiscal year (FY) 2006-2007 who were also part of the VA's External Peer Review Program (EPRP) FY 2007 random sample and who received care from VA facilities (N=107 facilities) with organizational data from the VA Mental Health Program Survey (N=7,514). EPRP included patient-level chart review quality indicators for common processes of care (foot and retinal examinations for diabetes complications; screens for colorectal health, breast cancer, and alcohol misuse; and tobacco counseling) and outcomes (hypertension, diabetes blood sugar, and lipid control). Results: Ten out of 107 (10%) mental health programs had colocated medical clinics. After adjustment for organizational and patient- level factors, analyses showed that patients from colocated clinics compared with those without colocation were more likely to receive foot exams (OR=1.87, p<.05), colorectal cancer screenings (OR=1.54, p<.01), and alcohol misuse screenings (OR=2.92, p<.01). They were also more likely to have good blood pressure control (<140/90 mmHg; OR=1.32, p<.05) but less likely to have glycosylated hemoglobin <9% (OR=.69, p<.05). Conclusions: Colocation of medical care was associated with better quality of care for four of nine indicators. Additional strategies, particularly those focused on improving diabetes control and other chronic medical outcomes, might be warranted for patients with serious mental illness.

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