UC San Diego

Background : The current United States (US) healthcare system focuses primarily on acute needs. As a result, the US ranks poorly in preventable mortality, and the incidence and prevalence of chronic conditions has increased. The "patient-centered medical home" (PCMH), a facility wherein patients' comprehensive healthcare needs may be met, is posited as an innovation for improving the healthcare system at lower costs. However, evidence regarding the effectiveness of the PCMH in improving health outcomes is limited. Additionally, a healthcare system that fails to address mental health will be incomplete and minimally effective. Consequently, an assessment of the effectiveness of the PCMH in improving the health, including mental health, of its patients is necessary. Objectives : This study examined the impact of transitioning clients from a Mental Health (MH) clinic to a patient-centered medical home (PCMH) on MH recovery). Methods : Data were drawn from a large US County Behavioral Health Services administrative data set. Propensity score analysis and multilevel modeling were used to assess the impact of the PCMH on MH recovery by comparing PCMH participants (n = 215) to clients receiving service as usual (SAU) (n = 22394). MH recovery is repeatedly assessed over time (days since baseline assessment range: 0-1,639, M = 186) by the Illness Management and Recovery (IMR) scale and the Recovery Markers Questionnaire (RMQ) Results : For total IMR (LR[chi]² (1) = 4696.97, p < .0001) and IMR Factor 2 Management scores (LR[chi]² (1) = 7.9, p = .005), increases in MH recovery over time were greater for PCMH participants than SAU participants. Increases on all other measures over time were similar for PCMH and SAU participants. Conclusions : Greater increases in MH recovery over time can be expected when patients with severe mental illness are provided treatment through the PCMH. Evaluative efforts should be taken to inform more wide-spread adoption of the PCMH