benjamin druss md, mph knowledge network summit october 3, 2013

IMPROVING HEALTH AND HEALTHCARE FOR MENTAL HEALTH CONSUMERS: FROM RESEARCH TO PRACTICE AND BACK AGAIN

Benjamin Druss MD, MPHKnowledge Network SummitOctober 3, 2013

1. Journal of the American Statistical Association Mar 1932;27(177A):160-174. 2. BMJ. 2011 Sep 13;343:d5422 3. 3. Nord J Psychiatry. 2012 Apr;66(2):97-106. Epub 2011 Aug 23.

A Widening Gap: Trends in Studies of Excess Mortality in Schizophrenia1

1970s 1980s 1990s1

1.5

2

2.5

3

3.5

4

Arch Gen Psychiatry. Oct 2007;64(10):1123-1131

Life Expectancy

Psychiatry Res. 2010 Apr 30;176(2-3):242-5Med Care. 2011 Jun;49(6):599-604

No Mental Disorder Any Mental Disorder General Population

Any Mental Disorder Public Sector

404550556065707580

Preventable Causes of Death

N Engl J Med. 2007 Sep 20;357(12):1221-8.

Health Care; 10%

Health Behav-iors; 40%

Genetics; 30%

Social/ Env-iornmental;

20%

Risk FactorsLifestyle

Medications

Chronic Medical Illnesses

A Public Health Approach

Primary Prevention

Wellness programs

Environmental Policies

Secondary Prevention Tertiary Prevention

TreatmentScreening

FOUR CORNERS WELLNESS PROGRAM

Four Corners seeks to build upon the supportive capacity of the CCSB to expand the scope of wellness and whole health services.

LET’S GET PHYSICAL! o Healthy Breakfasts Provided By Peerso Have YOU had Your Annual Physical?o Nationally Distributed Cookbooko Integrated Healthcare Peer Blogo Certified Fitness instructoro Cooking Demonstrationso Relaxation Roomo Walking Groupso Fitness Room

WELLNESS GROUPSo Stress

Managemento

Recovery/Wellness

o Healthy Living o Leisure Skills o WHAM

COMMUNITY BASED PROGRAMS

o Intensive Case Management

o Linkage To Specialty Careo Home Based

Assessmentso Community Outreacho CSI Services

LET’S GET PHYSICAL!

Schizophrenia and Bipolar Disorder Measure Set for HEDIS 2013Measure Name First-Year Results for

Medicaid HMOs

Adherence to Antipsychotic Medications for Individuals with Schizophrenia

58.5%

Diabetes Screening for People with Schizophrenia or Bipolar Disorder Who Are Using Antipsychotic Medications

78.0% (Glucose or HbA1c test)

Diabetes Monitoring for People with Diabetes and Schizophrenia

67.8%

Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia

77.6% 

Building a Health Home for People with SMI

REFER

Buy: The VA Integrated Care Clinic

Refer: The Primary Care Access, Referral and Evaluation (PCARE) Project

NIMH R01MH070437

Costs

0

2000

4000

6000

8000

10000

Tota

l Co

st (

$)

Cont rolCase Cont rolCase1-year 2-year

Probability of cost offset: 92.3% or 96.1% excluding extreme outliers

Medicaid Health Home State Plan Amendments

Rent

NIMH R01MH070437

SAMHSA PBHCI Program

1. Funded by NIMH R34MH078583\2. Lorig K et al. Med Care. 2001 Nov;39(11):1217-23.

Engaging Patients in Health Care

NIMH R01MH090584

Supporting Health Homes with IT

Registries and Measured Care

Patients: Personal Health Records

Going Mobile

MOBILE PERSONAL HEALTH RECORD

mPHR

Medical Records

Medications

Appointments

Messages

Health Goals

Building Data Infrastructure

Next Steps

A Virtuous Cycle

Evidence-Based Practice• Investigator-developed interventions

Practice-Based Evidence• Community-developed interventions