Accuracy of Primary Care Medical Home Designation in a Specialty Mental Health Clinic
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Accuracy of Primary Care Medical Home Designation in a Specialty Mental Health Clinic Maria E. Garcia 1 & Elizabeth L. Goldman 2 & Marilyn Thomas 3 & Stephen Chan 4 & Fumi Mitsuishi 5 & Dean Schillinger 2 & Christina Mangurian 6
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
To assess whether primary care medical homes (PCMHs) are accurately identified for patients receiving care in a specialty mental health clinic within an integrated public delivery system. This study reviewed the electronic records of patients in a large urban mental health clinic. The study defined ‘matching PCMH’ if the same primary care clinic was listed in both the mental health and medical electronic records. This study designated all others as ‘PCMH unknown.’ This study assessed whether demographic factors predicted PCMH status using chi-square tests. Among 229 patients (66% male; mean age 49; 36% White, 30% Black, and 17% Asian), 72% had a matching PCMH. Sex, age, race, psychiatric diagnosis, and psychotropic medication use were not associated with matching PCMH. To improve care coordination and health outcomes for people with severe mental illness, greater efforts are needed to ensure the accurate designation of PCMHs in all mental health patient electronic records. Keywords Care coordination . Serious mental illness . Primary care medical home
Introduction People with severe mental illness (SMI) such as psychosis, bipolar disorder, or severe major depressive disorder have shorter life expectancies, dying on average 10–25 years earlier than the general US population [1]. High incidences of diabetes, obesity, coronary artery disease, hyperlipidemia, and cancer in the setting of limited access to preventive services and fragmentation of care contribute to this stark disparity [1, 2]. Many patients with SMI are prescribed psychotropic medications, further increasing risk of cardiometabolic disease [3]. Yet patients with SMI are less likely to be screened for cardiovascular risk factors [4]. National efforts to improve preventive care and the overall health of people with SMI have promoted a
Maria E. Garcia and Elizabeth L. Goldman contributed equally to this work.
* Maria E. Garcia [email protected] Extended author information available on the last page of the article
Psychiatric Quarterly
shared care model, with coordination of care between specialty mental health and medical care settings, to promote cardiometabolic risk screening [3, 5–7]. While this approach has been used in the United Kingdom, fragmentation of specialty mental health and medical care settings makes this approach more difficult to implement in the United States. A critical first step to improve coordination of care between specialty mental health and medical care is having accurate provider contact information readily available to healthcare team members [8, 9]. The adoption of electronic health records to create a digital health care infrastructure is intended to improve coordination of care and facilitate communication [10].
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