title: SMI life goals: description of a randomized trial of a collaborative care model to improve outcomes for persons with serious mental illness.
abstract: BACKGROUND
  Persons with serious mental illnesses (SMI) are more likely to die earlier than the general population, primarily due to increased medical burden, particularly from cardiovascular disease (CVD). Life Goals Collaborative Care (LG-CC) is designed to improve health outcomes in SMI through self-management, care management, and provider support. This single-blind randomized controlled effectiveness study will determine whether patients with SMI receiving LG-CC compared to usual care (UC) experience improved physical health in 12 months.
  
  
  METHODS
  Patients diagnosed with SMI and at least one CVD risk factor receiving care at a VA mental health clinic were randomized to LG-CC or UC. LG-CC included five self-management sessions covering mental health symptom management reinforced through health behavior change, care coordination and health monitoring via a registry, and provider feedback. The primary outcome is change in physical health-related quality of life score (VR-12) from baseline to 12 months. Secondary outcomes include changes in mental health-related quality of life, CVD risk factors (blood pressure, BMI), and physical activity from baseline to 12 months later.
  
  
  RESULTS
  Out of 304 enrolled, 139 were randomized to LG-CC and 145 to UC. Among patients completing baseline assessments (N = 284); the mean age was 55.2 (SD = 10.9; range 28-75 years), 15.6% were women, the majority (62%) were diagnosed with depression, and the majority (63%) were diagnosed with hypertension or were overweight (BMI mean ± SD = 33.3 ± 6.3). Baseline VR-12 physical health component score was below population norms (50.0 ± SD = 10) at 33.4 ± 11.0.
  
  
  CONCLUSIONS
  Findings from this trial may inform initiatives to improve physical health for SMI patient populations.
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA. Electronic address: Amy.Kilbourne@va.gov.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA. Electronic address: Margretta.bramlet@va.gov.
authors.forename: Margretta
authors.initials: M
authors.lastname: Bramlet
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA. Electronic address: Michelle.barbaresso@va.gov.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Barbaresso
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA. Electronic address: kmnord@umich.edu.
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Nord
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA. Electronic address: David.Goodrich2@va.gov.
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA. Electronic address: Zongshan.Lai@va.gov.
authors.forename: Zongshan
authors.initials: Z
authors.lastname: Lai
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: Edward.Post@va.gov.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Post
authors.affiliation: Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104-2321, USA. Electronic address: dalmiral@umich.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Almirall
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA. Electronic address: Lilia.verchinina@va.gov.
authors.forename: Lilia
authors.initials: L
authors.lastname: Verchinina
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; University of Michigan School of Nursing, Division of Health Promotion and Risk Reduction, 400 N Ingalls Bldg, Rm 3178, Ann Arbor, MI 48109-5482, USA. Electronic address: bump@umich.edu.
authors.forename: Sonia A
authors.initials: SA
authors.lastname: Duffy
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System 152M, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA. Electronic address: Mark.Bauer@va.gov.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003299:Cooperative Behavior; D015444:Exercise; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D050177:Overweight / Q000453:epidemiology*; D018802:Patient-Centered Care / Q000458:organization & administration*; D011446:Prospective Studies; D011788:Quality of Life; D012107:Research Design; D012307:Risk Factors; D012648:Self Care; D016037:Single-Blind Method; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Care management; Mood disorders; Schizophrenia; Self-management
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