Integrated Healthcare Without Walls: Innovative strategies to address healthcare needs of severly mentally ill individuals

Background: Individuals with severe mental illness (SMI) have a higher incidence of other diseases including diabetes and cardiovascular diseases and a 25-year shorter lifespan, with limited access to quality healthcare services. Using advanced-practice nurses (APNs), Integrated Health Care (IHC), a nurse-managed center of the College of Nursing, University of Illinois at Chicago, provides primary physical and mental healthcare services for people with SMI and with or at risk for co-morbid chronic physical disease. But in spite of the fact that IHC has grown to four clinic sites, services remain inaccessible for homebound and isolated SMI clients.

Methods: A new primary care outreach program, called IHC Without Walls (WOW), was initiated in Fall 2007 aimed at dramatically increasing access to integrated primary care in order to improve health outcomes for these vulnerable, hard-to-reach SMI individuals through an innovative combination of strategies including APN a) house calls, b) group visits, and c) telemonitoring.

Results: This presentation will detail lessons learned and progress made towards the achieving the following objectives:

1. Providing primary care house call services for homebound SMI clients,

2. Implementing primary care APN group visits complemented with home telemonitoring of clinical status and adherence to therapies;

3. Improving client health outcomes:

a. Increased therapy adherence for clients on multiple drug therapies;

b. Improved physical health status of at-risk diabetic, hypertensive and obese clients;

c. Improved client mental health status and socialization; and

d. Improved cost-benefit and cost-effectiveness .

Conclusions: The higher incidence of chronic disease and shorter lifespan of individuals with SMI is a serious public health issue. Use of data-based evaluation methods for developing evidence-based practice is critical to demonstrate outcomes of new models of care. The evidence from this nurse-managed outreach program for hard-to-reach SMI individuals could facilitate replication, resulting in improved clinical outcomes, health promotion, and prevention of future disability for this vulnerable population. In addition, this project will inform other community-oriented programs of potential cost-effective models for serving hard-to-reach, homebound, and isolated vulnerable groups.