The Chronic Care Model and Persons with Severe Mental Illness: An Integrated Approach to Care. Presenters / Disclosures.

Transcription

1 The Chronic Care Model and Persons with Severe Mental Illness: An Integrated Approach to Care Mélinda McCusker, PMHNP Dawn Vanderhoef, PhD, DNP, PMHNP/CNS-BC Assistant Professor Vanderbilt University School of Nursing Presenters / Disclosures Mélinda McCusker, PMHNP PMHNP, Baylor Scott & White Health Instructor, Texas A&M College of Medicine Clinical Instructor, University of Texas School of Nursing Doctoral Student, Medical University of South Carolina No disclosures or conflicts of interest to report Dawn Vanderhoef, PhD, DNP, PMHNP/CNS-BC Assistant Professor, Vanderbilt University School of Nursing No disclosures or conflicts of interest to report Objectives Describe the rates of cardiometabolic illness in persons with a severe mental illness Identify various integrated care models and measures of integration Examine how the Chronic Care Model can be used as an integrated care model to address cardiometobolic illnesses in persons with a severe mental illness McCusker, Vanderhoef 1

2 Rates of cardiometabolic illness in persons with a severe mental illness Persons with a severe mental illness (SMI) prematurely lose years of life as compared to the general population (Miller et al., 2006) Cardiovascular disease is the most common cause of excessive mortality in this population (Richardson et al., 2005) Causes of cardiovascular disease and premature death, such as hypertension, obesity and diabetes, have been associated with antipsychotic medication use (Amiel et al., 2008) Persons with schizophrenia and bipolar disorder have an increased risk for diabetes and obesity and develop cardiovascular disease at rates twice that of the general population (Daumit et al., 2002; Saha et al., 2007) Chronic care management for persons with a severe mental illness Chronic care management of persons with a SMI requires understanding that a diagnosis of a severe mental illness is an independent risk factor for the development of cardiovascular disease Disparities in primary care exist for persons with a severe mental illness Despite receiving more time with a provider, patients with a severe mental illness do not typically receive screening and preventive services Persons with severe mental illness develop chronic multimorbid health problems The U.S. healthcare system is reactive tyranny of the urgent (Wagner et al., 2006) What is integrated care? Collaborative Care: BH working with PC Integrated Care: BH working within PC Concepts Common to Models of Care Patient tracking / registry Nonprovider for CM Adoption of EB-guidelines Patient self management support and test (screening) Referral tracking (Collins, Levis Hewson, Munger & Wade, 2010) McCusker, Vanderhoef 2

3 Collaborative & Integrated Care (Blount, 2003) Coordinated Co-Located Integrated Routine BH screening in PC Medical services and BH in same facility Medical and HC in same facility or separate locations Referral relationship Information exchange Referral process medical patients seen by BH Enhanced BH and PC communication due to proximity One treatment plan Medical & BH Team care protocol use PC deliver BH using algorithms Connections for patient with community resources Consults between BH and PC Increase level & quality of BH services with lower BH noshow rates Teams MD and / or NP, PA, Nurse, CM, Family, Therapy Database to track care The Four Quadrant Model (Mauer, 2005) Quadrant II BH PH BH case manager coordinates with PCP Specialty BH / Residential BH Crisis ER BH IP Other supports Quadrant I BH PH PCP based BH Quadrant IV BH PH BH case manager works with PCP and Disease Manager Specialty med / surg Specialty BH / Residential BH Crisis ER BH IP / med / surg specialty IP Other supports Quadrant III BH PH Disease Manager Specialty med / surg PCP based BH ER Med / surg specialty IP Other supports The Chronic Care Model Developed by Wagner and colleagues (1998) to address the lack of access to care and poor quality associated with management of persons with chronic illness Provides a systems framework for addressing the wide range of health needs for chronically ill populations Multidimensional solution that will guide practice through the interaction of the six systems Develops informed empowered patients and a prepared proactive practice team that synergistically create productive interactions leading to improved health outcomes (Bodenheimer et al., 2002) McCusker, Vanderhoef 3

4 The Chronic Care Model used as an integrated care model What is the Chronic Care Model? Wagner et al. (2001) Levels of Elements McCusker, Vanderhoef 4

5 SMI + CMI CCM = How does it apply to persons with SMI? Severe mental illness (SMI) = Chronic Illnesses Cardiometabolic Illnesses (CMI) = Chronic Illnesses Literature Review Initially created for diabetes (Wagner et al., 2001) Validated for various SMI Depression: Holm and Severinsson (2012) Recommended by the Agency for Healthcare Research and Quality (McDonald et al., 2007) Implications What does it mean to practice? AKA: What does it mean to me? Each element has specific target activities CCM Elements Relating to CMI in Persons with SMI Self-Management Support Decision Support Delivery System Design Clinical Information System Healthcare Organization Community Resources McCusker, Vanderhoef 5

6 Wake up from nap/questions? Thank you! ~Mélinda & Dawn McCusker, Vanderhoef 6