• Alexander S Young, Evelyn T Chang, Amy N Cohen, Rebecca Oberman, Dennis T Chang, Alison B Hamilton, Laurie A Lindamer, Jesse Sanford, and Fiona Whelan.
• Greater Los Angeles Veterans Healthcare System, Los Angeles, CA, USA. ayoung@ucla.edu.
• J Gen Intern Med. 2022 Oct 1; 37 (13): 325832653258-3265.

BackgroundThere are unmet primary care needs among people with serious mental illness that might be improved with integrated care and medical care management. Many healthcare organizations have attempted to address this problem, but few interventions have been rigorously studied and found to be effective.ObjectiveStudy the implementation and effectiveness of a novel, specialized primary care medical home designed to improve the healthcare of patients with serious mental illness.Design, Setting, And ParticipantsClustered controlled trial for a median of 401 days. One Veterans Health Administration medical center was assigned to intervention and two were assigned to usual care (control). Thirty-nine clinicians and managers were included in the study, as well as 331 patients who met eligibility criteria.InterventionA specialized medical home with systematic patient engagement, proactive nurse panel management, a collaborative care psychiatrist, and a primary care physician providing care that included psychiatric treatment.Main MeasuresQuality of care, chronic illness care and care experience, symptoms, and quality of life.Key ResultsSixty-five intervention patients (40%) moved all psychiatric care to the primary care team. No adverse events were attributable to the intervention. Compared with control, intervention patients had greater improvement over time in appropriate screening for body mass index, lipids, and glucose (χ2 = 6.9, 14.3, and 3.9; P's < .05); greater improvement in all domains of chronic illness care (activation, decision support, goal-setting, counseling, coordination) and care experience (doctor-patient interaction, shared decision-making, care coordination, access; F for each 10-24, P's < .05); and greater improvement in mental health-related quality of life (F = 3.9, P = .05) and psychotic symptoms (F = 3.9, P = .05).ConclusionA primary care medical home for serious mental illness can be feasible to implement, safe, and more effective than usual care.Trial RegistrationClinicalTrials.gov Identifier: NCT01668355.© 2022. This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply.

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