173924 Integrated Healthcare Without Walls: Innovative strategies to address healthcare needs of severly mentally ill individuals

Monday, October 27, 2008: 1:10 PM

Judith Lloyd Storfjell, PhD, RN , College of Nursing, University of Illinois at Chicago, Chicago, IL
Kathy Christiansen, PhD, RN , College of Nursing, University of Illinois at Chicago, Chicago, IL
Arlene Miller, PhD, RN , College of Nursing, University of Illinois-Chicago, Chicago, IL
Judith McDevitt, PhD, FNP , Department of Public Health, Mental Health, and Administrative Nursing, University of Illinois at Chicago, Chicago, IL
Marsha Snyder, PhD, CNS , College of Nursing, University of Illinois-Chicago, Chicago, IL
Emily Brigell, MS, RN , College of Nursing, University of Illinois-Chicago, Chicago, IL
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.

Learning Objectives:
By the end of the session, participants will be able to: 1. Discuss innovative strategies to address the major healthcare needs of severely mentally ill (SMI) individuals. 2. Articulate the impact that group primary care can have for individuals with SMI. 3. Identify telemonitoring applications for SMI clients.

Keywords: Mental Illness, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Principal Investigator of this HRSA-funded project
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.