Literature Collection

BACKGROUND: Strategies are needed to better address the physical health needs of people with serious mental illness (SMI). Enhanced primary care for people with SMI has the potential to improve care of people with SMI, but evidence is lacking. OBJECTIVE: To examine the effect of a novel enhanced primary care model for people with SMI on service use and screening. DESIGN: Using North Carolina Medicaid claims data, we performed a retrospective cohort analysis comparing healthcare use and screening receipt of people with SMI newly receiving enhanced primary care to people with SMI newly receiving usual primary care. We used inverse probability of treatment weighting to estimate average differences in outcomes between the treatment and comparison groups adjusting for observed baseline characteristics. PARTICIPANTS: People with SMI newly receiving primary care in North Carolina. INTERVENTIONS: Enhanced primary care that includes features tailored for individuals with SMI. MAIN MEASURES: Outcome measures included outpatient visits, emergency department (ED) visits, inpatient stays and days, and recommended screenings 18 months after the initial primary care visit. KEY RESULTS: Compared to usual primary care, enhanced primary care was associated with an increase of 1.2 primary care visits (95% confidence interval [CI]: 0.31 to 2.1) in the 18 months after the initial visit and decreases of 0.33 non-psychiatric inpatient stays (CI: - 0.49 to - 0.16) and 3.0 non-psychiatric inpatient days (CI: - 5.3 to - 0.60). Enhanced primary care had no significant effect on psychiatric service and ED use. Enhanced primary care increased the probability of glucose and HIV screening, decreased the probability of lipid screening, and had no effect on hemoglobin A1c and colorectal cancer screening. CONCLUSIONS: Enhanced primary care for people with SMI can increase receipt of some preventive screening and decrease use of non-psychiatric inpatient care compared to usual primary care.

Objectives: We aimed to investigate how receiving integrated healthcare services from a case manager via instant messaging affected patients with disabilities. Methods: This database-matched case-control study was conducted at one medical center. Patients with officially certified disabilities were recruited and assigned to either the LINE-based group or the control group, which accessed services in the traditional manner. Their baseline characteristics were collected through chart reviews. Medical service utilization data-including their number of outpatient visits, prescribed medications, and hospitalizations-were obtained at baseline and 3, 6, and 12 months into the intervention. In the LINE group, quality of life, caregiver burden, and perceived social support were also assessed. A repeated-measures ANOVA was used to analyze within- and between-group differences over time. Results: Both the LINE group and the control group contained 66 patients. The number of outpatient visits (p < 0.001) and quantity of medication taken (p = 0.026) were significantly lower in the LINE group than in the control group. Furthermore, the caregiver burden in the LINE group (p = 0.024) was significantly lower 12 months after receiving integrated healthcare services. Conclusions: Providing integrated healthcare services via instant messaging enabled patients with disabilities to access medical services promptly and efficiently, thus enhancing the accessibility of healthcare and improving care for the disabled population.

BACKGROUND: A prior randomized trial assessed three care management (CM) interventions that were designed for adults at high risk of negative health outcomes following a hospital admission and implemented by a large health plan. These CM interventions positively and equivalently impacted several patient-centered outcomes over time. OBJECTIVE: Use the prior randomized trial as the basis for testing post-hospitalization utilization and cost impacts (1) across three CM models (primary analysis) and (2) for each CM model (secondary analysis). DESIGN: Post hoc comparison of three randomly assigned integrated CM interventions (IC) and a randomly selected, contemporaneous usual care control group (UC). PARTICIPANTS: Recently discharged high-risk Medicaid or dual-eligible Medicaid/Medicare members with multiple chronic conditions. INTERVENTIONS: Three CM interventions: high-tech (4-12 months of remote patient monitoring with video visits/condition-specific texts and telephonic visits; n = 365); high-touch (4-12 months of telephonic visits; n = 335); optimal discharge planning (ODP; 2-4 weeks of telephonic visits; n = 149). All three included an initial in-person visit. MAIN MEASURES: Ninety-day readmission and emergency department (ED) visit rates; 12-month member care costs (total, medical, pharmacy). KEY RESULTS: UC had access to, but rarely used, traditional health plan CM. Compared to UC members (N = 886), IC members (N = 886) had similar total cost of care (p = 0.58). IC pharmacy costs trended 93.6% higher (p = 0.06) while medical costs trended 52.5% lower (p = 0.10), despite higher 90-day ED visit rates (IC 32.4% vs. UC 25.5% UC, p = 0.001) and no impact on 90-day readmission rate (IC 16.5% vs. UC 16.3%, p = 0.90). None of the three CM interventions showed an overall comparative advantage, despite some variations in their post-discharge utilization and cost impacts. CONCLUSIONS: The three post-discharge CM interventions tested showed promise as cost-neutral interventions within a large health plan setting. CM engagement may reduce medical cost specifically despite its impact on readmissions and ED use, though further evaluations of CM interventions are needed.