Positive outcomes for SPMI patients receiving integrated care in a multi-state study

Background: Severely and persistently mentally ill (SPMI) individuals die 25 years earlier, on average, than the general population. Poor access to medical care and elevated rates of chronic conditions contribute to shortened lifespans for this population.  In response to this problem, community mental health and federally qualified health centers in Ohio, Indiana, and Kentucky partnered to integrate primary care and behavioral health services for SPMI individuals. Methods:  Adult SPMI patients in the Greater Cincinnati area received coordinated medical, behavioral health, and prevention services from one of six integrated-care clinics. Outcome measures including hemoglobin A1c levels, cholesterol (LDL-C) levels, blood pressure, depression (PHQ-9) scores, and body mass index (BMI) were obtained from January 2012 through December 2014. ANOVAs and t-tests were conducted to assess change from baseline to follow-up. Results: Data were collected from 2,220 SPMI patients receiving integrated services.  Eighteen percent of patients presented with diabetes, 44% with hypertension, 33% with hyperlipidemia, and 75% had a BMI > 25. Patients showed significant improvement in blood pressure, LDL-C, and PHQ-9 score from baseline to follow-up (p’s<0.001).  Patients who received integrated care for greater than one year showed significantly more improvement in outcome measures than those patients who received integrated services for less than one year (p’s<0.05). Conclusions: SPMI patients in this region experienced poorer physical health compared to the general population in the same counties. Providing SPMI patients with integrated care positively impacted their health, supporting an important role for health integration in the prevention and treatment of chronic conditions in this population.